VBG Revision Insurance Coverage?

 

Hello,

I had a VBG (No longer done) in 8/2000 self-pay.  I only lost a total of 60 lbs and started gaining back right away, after about 12 months.

Kept gaining and have been back up to pre WLS weight for several years.  I have had no medical issues except GERD over the years and some food sticking in the ring causing me to have to throw it up to get un-stuck. Maybe an Ulcer.

I gained the weight back because I learned to eat around the ring with foods that were easy to eat rather than ones I could not eat.

I blame (hate) myself for the weight gain and do not feel like the VBG failed me, I failed to make the most of my tool.

Anyway today I have such bad GERD I think I need to have the ring removed.  I am extremely fearful that  if I just have the ring removed I will gain even  more weight.

Has anyone had insurance cover a revision or conversion with a lower BMI of 35.8. 

What is considered medically necessary?  I have such bad GERD that if I have to I will pay out of pocket to get it fixed.  I have been living on Prilosec for  5 years.    

I am burping constantly and food burns.  My stomach is upset almost all the time.  I would rather not have anything done but it's getting to the point where I feel like I must.   

 

Anyone ever had a VBG revised-converted to another type of weight loss surgery for GERD and weight gain?  Has anyone had their insurance pay for it?  What needs to be wrong for it to be considered medically necessary?  I have Regence Innova coverage.

 

Any insights would be greatly appreciated.

 

Thank you,

Eileen

So sorry you are having such a horrible time! I have a band so kinda understand, had it emptied a year ago and that helped. Anyway it's very hard to tell if insurance will cover or not, you'd really have to discuss it with your own ins. co. because they are all different. Some will go ahead no problem and others make you fight tooth and nail. Some just flat won't do it and have exclusions. So your best bet is to ask them directly. I wish you luck, that has to be an awful way to live!

 

Hi,

Thank you for your thoughts and advice!

 

 

I could have written your post almost exactly!!! I had the VBG in 2006...Dr. Weber was the only surgeon (that i know of) that was still doing them in the Seattle, WA area. I lost 100 pounds but gained most of it back after about a year and a half and a pregnancy. Due to the same reasons you gained!! Food stuck constantly, etc....

In 2009 i was revised to the DS and insurance covered it for me. I can't remember what my BMI was...i was 5'5" and weighed 240.

Life now is so much better!!! Nothing ever gets stuck!!! And it has been over 3 years and I now weigh 125!!! Best decision i could have made regarding my weight loss!!!

Good luck!!?

Lisa

Hi,

OMG, Perhaps there is hope after all.

I've heard that Dr. Weber's patients with

VBG are seeking revisions.  I hope I can

turn out as well as you have.  Congratulations

on your success and I wish you well!  ;>)

 

Thanks,

Call your insurance to see if they pay for weight loss surgery.  GERD is a comorbidity do you have any others:  high blood pressure, sleep apeina, high cholesterol, urinary stress incontinence (to name a few). 

It appears most insurances that cover WLS require 2 comorbidities with a BMI between 35 and 39.9; one comorbidity with BMI of 40 and above. 

Sorry you are dealing with GERD and hope you can proceed soon with another procedures.  Please be sure to research all surgeries they are quiet different and choose the one that would be serve you.

Hi,

Thank you for taking the time to respond to my post.  You've been most helpful.  I'll call my insurance company today.

 

Thanks!

Hi Eileen, 

I am a band to RNY revision because of severe GERD (RNY cured it) and my insurance covered the revision due to GERD being a complication caused by the band.  I think my BMI was about 35 at the time of my revision.  

All my insurance required besides the evaluation by the surgeon was an upper GI showing the reflux, which was easy enough to get.  I have severe esophageal damage from the GERD caused by the band and am on medication, which hopefully is repairing some of the damage.  My GI doc plans on a scope either this year or next to check things out (I forget which he said -- but I see him next month so no biggie).   

I also have a huge amount of scarring to my stomach due to the band so my RNY pouch is larger than a normal RNY pouch would be in a person with no previous weight loss surgeries.  I found out after the fact that this is normal due to the scar tissue that develops to help keep the band secured in place.  They have to run the suture lines on the outside of the scarred tissue so that the staple line goes all of the way through the stomach tissue in order to prevent any leakage.

Anyway, I hope this helps.  Feel free to go to my profile and read my blog.  I outlined my experience and you may find something in there that may help you with your situation.  

I saw your post on the LW board but since I was a day late, figured I'd try to catch you over here.  In any case, welcome and best of luck to you!!!!

Hi Turtle Lynn,

Thank you for the post!  I very much enjoyed you blog and did

appreciate your journey.  I can relate!  Sounds like you are doing very

well and I'm happy for you.  I hope one day you can take your teenage

Daughter's jeans and they will be loose on you too!   I can't imagine

what it would feel like to fit into skinny jeans.  Anyway I feel better

after reading about how things went for  you.  

Thank you so very much for reaching out and sharing!

 

 

Eileen 

I second what others have said about the BMI and insurance guidelines.

But ALL insurances are different.  So, you need to see what your policy says.

I see you are in Washington.  No one in Washington or Oregon does the DS, but I looked on DSFacts website, and here is the listing for the California surgeons.  And an Idaho surgeon as well is on the bottom:

California

Gregg Jossart, MD *

Sutter Pacific Medical Foundation
1375 Sutter Street, Ste 208
San Francisco, CA 94109
Phone: 415-923-3200

Peter Crookes, MD, FRCS, FACS

USC Bariatric Surgery Program
University of Southern California
1510 San Pablo Street, Suite 514
Los Angeles, CA 90033
Phone: 323-442-6219
Fax: 323-442-6280

Ara Keshishian, MD, FASMBS, FACS *
Email: [email protected]

Central Valley Bariatrics
Phone: 818-812-7222
Fax: 818-952-0990

Primary Office:
1808 Verdugo Blvd., Suite 413
Glendale, CA 91208

Satellite Office:
Delano Regional Medical Arts Building
1205 Garces Highway, Suite 303
Delano, CA 93215

John M. Rabkin, MD, FACS *

Pacific Laparoscopy
2250 Hayes Street, 3rd Floor
San Francisco, CA 94117
Phone: 415-668-3200 or 1-888-848-8446 toll free
Fax: 415-668-2010
Email: [email protected]

 

Idaho

W. Christian Oakley, MD, FACS

St. Luke's Metabolic and Bariatric Surgery Clinic
333 North 1st Street, Suite 120
Boise, ID 83702
Phone: 208-381-7190