Possible Revision...

Hi :)

I am scheduled for an upper GI on thursday and followup with my surgeon on Friday... I am concerned that my insurance will not cover a revision even if my band has failed because my bmi is still relatively low and I do not think I have a comorbidity...

I have Federal (FEP) Blue Cross blue shield.. Can anyone provide insight about revision approval process with this insurer?

What is your BMI?  Usually you have to meet the same requirements as your original surgery.  Also, be sure to see if your ins co is one of the many who are going to the standard policy of one WLS per lifetime.

Guidelines sure have changed. When I first got my Lapband there were very few requirements written in the guideline book but through the years it has changed For sure. Thanks

My dr. Said that if the surgery failed or any part of it failed insurance should cover it. If you didn't follow guidelines then you have to go through the approval process just like the first time. Each case is different every insurance company treats every patient different. They initially denied my revision said I didn't follow the guidelines. I had to prove to them I had tothe best of my ability. I followed the dietary but not the exercise because I had a back injury and 13 surgeries and both my knees done. So within 4 days of my denial they approved on a failed surgery. I was just prepared to do the whole thing all over again but I didn't have to. So every case is individual. Your dr. Knows what he needs to say if he wants to. Don't you guys go yearly to get adjusted and tightened if you want. Here in az they do.

Hi yes you're right. Thank you those were very good points. The main issue with approvals at this point is me having a low bmi because my band did work so well for me for a while. I did follow program and the insurance clerk who I had a long talk with yesterday said she's going to show all of that. She said my low bmi is the issue. I will appeal and if that doesn't go through I will self pay if I have to but really don't want to it will break me financially but I would rather be dead that morbidly obese again so I have no choice.

 

With a low BMI I think you are going to be in for a battle.

If you do self pay I would do as most self pays do, go to Mexico.  :o/

You should go to your BCBS guidelines which can be found online. They should clearly document the requirements for revision. I have BCBS but not federal.

They WILL usually remove the band if there is medical necessity - revision to another surgery is a different story.  My requirements were that you met the same initial criteria.  I only ever lost 27 pounds with the band, so I did not have to worry about that part.

 

Yes I've read the guidelines. But since I am on the federal plan we usually have that extra "Umph" to get approvals for appeals etc. that's why I referred to the board here. But I appreciate your feedback

Hey Trish,

I tried to reply to your FB message but for some reason I couldn't. I have BCBS FEP also and when I had my revision a few years ago, my BMI was 27. They approved my sleeve in two weeks, as you know I had 2 band slips and was vomiting constantly. I was terrified of a leak and complications but I chose a very experienced revision surgeon and thankfully had no complications. I got down below goal and maintained for over a year. I'm battling with a 20 pound regain but that's because I quit smoking last year and have been eating crap, My sleeve is still doing its job. Email me if you want to talk.