Did BCBS Federal approve your Revision?

I have BCBS Federal.  I had a Lap Band in 2008, lost 17 lbs and gained 20 lbs.  I had a Sleeve in 2009, lost 30 lbs and gained 20 lbs.  Yes, this will be #3.  I was denied in last year, because they said I was not in compliance with the last 2 surgeries.  Even though, they only paid for 1 the LB, I did self pay for the Sleeve. My surgeon is going to request this Revision Surgery RNY for Medical Necessity because of my Hiatal Hernia which causes severe acid reflux, after I do the 3 month program with the Nutritionist and Exercise program.  

I have my appointment with the Psychologist this Friday, 09-08-14.  How did it go with your approval/disapproval with BCBS Federal?  

Thanks for your replies.

It depends on what your coverage is and only the insurance company can tell you that. Even if someone else has the same company they won't have the same coverage.

Hi Hislady,  

It's nice to hear from you again.  You have always been kind to me with your replies.  I did read my policy and already know that Revisions are covered.  I just wanted to see if there were any others that were approved right away or did they get denied and then appeal?  There are so many Insurances that have the Blue Cross Blue Shield name and can be so different.  I am just trusting in the Lord, to see if it gets approved, if it doesn't then I will know it's not His will for me to get a 3rd surgery.  Meantime, I'm waiting on Him and doing a 4 month visit with the Nutritionist and started exercising and keeping a journal.  Tomorrow I have an appointment with the Psychologist.   If I don't get approved I believe He will heal my Hiatal Hernia.  I know you are a Christian lady, so please keep me and my situation in prayer.    Thanks!

I had a revision from Lap Band to RNY after only having the lap band 2 years. Federal BCBS paid it and I had no problem at all getting approved.

May I ask why you revised, besides the LB not working?  Did you gain wait after a while with the LB?  

Thanks for your reply!

I decided to get a revision when after going in for multiple fills and unfills I was not able to really hold anything down. I would get sick and "get rid of" anything I ate and sometimes drank. My daughters literally would know that if we went anywhere to have dinner we needed to be seated near the restroom because I would make at least a trip in there to throw up. It went on for 6 months. When I met my RNY surgeon he had my band opened up fully and for the first time in a long time I could actually eat. I actually lost weight when the band was fully opened. I think my body was in starvation mode and wouldn't budge with what I had. Also, when you can't eat anything you resort to what will "slide" or melt. I am so happy with my RNY. I am pretty new with it, but I feel a whole lot better having had it done.

I understand, my food would come back up sometimes, I could not find the "sweet spot" and the LB Surgeon said that he repaired my hiatal hernia at the same time this was in 2008.  However, my reflux came back and I was ready for a revision, but needed to know the options.  I had lost 17 lbs and gained 14 with the LB.  In 2009,  I went to a seminar with a different surgeon and was informed about the VSG (Sleeve) the surgeon was all gun ho about it.  When he did the Sleeve he too said he repaired the hh.  No, it's not repaired I still have the horrible reflux and the hh is bigger than before.  Ok, I gained most of my weight back. Here's my problem.   BCBS Federal last year 2013 denied me for a revision because I was not in compliance with the eating, exercising program, with the past 2 surgeries.  They covered the LB and the removal of the LB, they did not cover the Sleeve, I did self pay.  So in reality they did not pay for 2 surgeries.  

My new surgeon that I hope to do the RNY said the hiatal hernia will be fixed and I should have no more problems with the acid reflux.  The LB and the Sleeve are notorious for hh and acid refux.  

Thanks for replying and please tell me what you think.  Blessings to you on your journey!!!

Hi,

Just curious if you have heard from insurance yet? I have BC/BS Federal standard option (105). I was self pay for my band and they paid for the revision to RNY. I had a slip and poor weight loss. Im now considering another revision. Im going for an endoscopy soon which is the first step for the insurance (if I decide to have the surgery). I cant do it without insurance. I know the 2015 coverage does have guidelines for revisions so I know they 'DO' cover.... Do you have the basic or the standard option? I think basic does not cover wls.

Hope you have had good luck!

Hi Mary B.,

I decided not to have another surgery after all.  It would have been a lost battle for me.  My doctor who did the Sleeve surgery wrote on my record that I was poor with the diet and exercise, etc.... He was right but I never cared for his bluntness and he was very unsupportive and rude.  I was going through a lot of crap in my life and had no motivation to change my lifestyle.   

I have gone back to the basics and I have lost 25 lbs.  I need to lose at least 25 more.  This would have been my 3rd surgery if I would have gone for it, but I probably would have had to do self pay.  I'm trying my very best now with what I have the Sleeve, to get to my goal.  I do have BCBS Federal Standard Option. 

Thanks so much for replying.  May you have a BLESSED NEW YEAR and great results with your next surgery if you decided to go that route.