Stretched Stoma covered by insurance?

(deactivated member)
on 3/7/12 8:57 pm
Hi All-
I just found out I have a VERY stretched stoma...apparently the same size as my pouch....
My insurance does not have a gastric rider meaning nothing bariatric surgery related would be covered and considered vluntary not medically needed....
Not only have I been gaining weight, but I'm not absorbing any of my vitamins and iron...
Has anyone gotten their revision covered due to this when insurance would not normally cover?
Toy T.
on 3/8/12 4:36 am
DS on 02/22/12
 You can call your insurance company and see. There was an insurance guru on here but I heard she was banned so you would have to find her at the other website. 
heathercross
on 3/8/12 9:13 am - New York, NY
 Its all very clear cut, pull your insurance rider and see what it says.  If you have a bariatric rider and if it covers a revision. I had a revision per se, to a Lap Band (over Bypass) and it wasn't treated/billed as a revision but a new procedure.
(deactivated member)
on 3/8/12 9:37 am
I have no gastric rider at all...that is why I am wondering if it can be considered a malfunction of the origional and get it covered that way
Toy T.
on 3/8/12 9:55 am
DS on 02/22/12
 She may have missed that part. Just call ur insurance company tomorrow. 
(deactivated member)
on 3/8/12 10:39 am - Hockessin, DE
Revision on 03/01/12
I just had a band over bypass last week to fix a stretched stoma and it was not covered by my insurance, I have Tricare, however I didn't appeal.  The best thing to do is call your insurance carrier and in my case I actually had to go through all the testing and have the doctor submit it for medical review and then Tricare made a decision.
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