Revision with Anthem Healthkeepers

Amanda S.
on 10/25/11 5:33 am - VA
RNY on 02/13/12
I currently have a lap-band and have started the revision process (to RNY), but I need to have an endoscopy and band fill under fluoro before the surgeon can submit anything to the insurance (I have Anthem Healthkeepers HMO with the obesity rider). Has anyone had any luck with getting a revision approved with this insurance? My surgeon said the endoscopy and band fill are needed to see if there is anything mechanically wrong with the lap-band because if there is it will be easier to get an approval from Anthem HK. I'm pretty sure there isn't, though- I've been completely unfilled for a little over a year now and haven't had any reflux or other problems with it since then (other than regaining all of the weight I lost and then some).

My mom actually had a lap-band revision to RNY with the exact same insurance, but I think there might have been a mechanical problem with her's. So...has anyone with this insurance been approved for a revision without the lap-band having a mechanical failure? My BMI is more than high enough and I have some co-morbidities now, but I'm afraid the insurance will come back with "You need to try harder." Although even with the lap-band I could only ever manage to get my BMI down to 32 (it's 44 right now) and at the point where I could start losing weight, I kept getting constantly stuck.
Hislady
on 10/25/11 6:42 am - Vancouver, WA
Really the only way to find out is to contact the insurance co., if they have a rider or provision against WLS it may not cover it. On the other hand if it is a failure of the band they may. So the only way to know for sure is to contact them. Good luck to you!!
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