u guys make me nervous....ref...bcbs...LOL

my company has just changed to bcbs..i have the stupid band, and i got down to 184....had a slip and hiatal hernia, was unfilled and couldnt go back to my bari dr. due to ins. denial....i had aetna, they covered the original surg. in 06, then told me i had an exclusion in 2010...anyway, i have been waiting for the ins. change and its happened !!! my co. switched to bcbs and wls is covered with prior approval from dr. soooo... i already had the surg, and i want a revision.....my bari drs office said that in order to get a revision, i need to have gained 50% of my weight back......i did lol plus 6 lbs..... so i dont know whats gonna happen, but i hope i dont have to jump through the appeal hoops again like i did with aetna.........THE WHOLE PROCESS IS SO DAMN NERVE WRACKING ISN'T IT ??????????

Hey neighbor!  Since you had your orginal surgery over 5 years ago, I really don't know how that works.  I was lucky, I had my revision within a year and my doctor's office did everything for me.  I didn't call the insurance once!   I didn't have to re-do anything, I just showed up where and when my dr's office said to!

It sounds as though you have medical necessity.  Why don't  you start the supervised dr visits NOW, like as in right when your plan changed, this way if you do need to do the 6 month supervision, you have a month or two down already.

Good luck!

Hi

I agree with Jennifer, start your supervised visits now and in the mean time go check on your band.  Go get an upper GI done and see what kinda shape the band is in.  I have BCBS of IL and they gave me hell to do my revision but I fought them all the way to the end.  What type of revision are you looking to have?

BCBS is the easier company to get an approval from... I had Aetna for my LapBand and BCBS for my DS... I would agree with the upper GI and an Endoscopy... I don't know about Supervised visits... I only had to do that under Aetna... Call the insurance company and find out what the requirements are...IMHO

Yes - I agree with both ladies who posted above me; I forgot to mention that I had both the upper GI and endoscopy prior to having the band removed.  I had the endoscopy in November 08, right when the reflux started to become unbearable, and the upper GI either right before or right after the last unfill.

I totally forgot about that!  

I hope your approval goes smoothly.  I just saw my surgeon today about revising from a crapband to the sleeve.  She didn't hesitate and said I would be a good candidate for the sleeve.  she said my insurance requires a 5-year history of my weight.  I hope that's it.  They will cover the surgery, the pre-op testing (including the nutritionist and a psych evaluation if it's required) at 100%.  Well, once I've paid $120 towards my out of pocket, then they'll pay at 100%!

I just finished all the paperwork my doctor's office requires and will be sending that in tomorrow.  Then they will put in for insurance approval, then they want to do an upper GI and scope to get a better idea of whether they can do the revision in one surgery or two.  The doc said there is nothing more disappointing then not knowing there is an erosion until you open someone up. 

Whether I get my revision in one surgery or two depends on the condition of my stomach and any band damage or scarring that may be present.  I got banded in June 2007 and have gained back all the weight I lost.

I hate waiting so the time is going to drag for me now until I get an approval.  The receptionist said it could take 6 months to a year????!!  WTF?  I don't believe it will take nearly that long, but who knows.  If I don't get it done by June 30 next year, they will only pay 80% instead of 100%, so I sure hope it doesn't take 6 months for approval!!

Dr. Goyal should have a list of requirements per insurance company. I dont think you have to do supervised diets all over again because of the slippage (dont quote me) or you can call the insurance company yourself and see exactly what you need....good luck!!!