Reversal from Band to RnY - Different Requirements? Difficult?
Hi I might have initially posted this to the wrong forum (I'm new) here goes -
I bet this topic has been discussed before so thank you for your help...I was banded in February, 2008. It took me 2 1/2 years to lose 80 pounds. I was at my lowest for a month, and then began gaining back immediately. Now, 4 years later, I have gained most of my weight back, shy about 20 pounds. I'm currently about 210 approx (I say that because I'm afraid to get on a scale) and am 5'2". At my last visit I asked about a reversal to another surgery (hopefully an RnY) and my Dr. agreed.
My question is - how difficult is it to get a reversal? Is it harder to get approval for a reversal then it was to get the operation in the first place? All of the information that my Dr. office requested is in and now its just a matter of waiting. There are a couple of things that concern me: 1. a requested proof of 5 years of obesity. I did LOSE weight....so I can't show 5 continuous years of obesity. 2. My BMI is not at the minimum of 40. In your opinion are these strikes against me?
I'm trying to keep my emotions out of this post. Don't mean to sounds like I have no emotional stake in this at all because I do. I'm trying to deal with just the practicalities of the process. It is a minimum of a one month wait to hear anything from the insurance company (so the Dr. office tells me). And it took the Dr. office a month to contact me with the insurance company's requirements. So I need to be in this for the long haul.
Any help / suggestions / words of wisdom would be welcome.
Thank you!!
J
You may have to appeal since you don't meet the requirements because this is a revision rather than a virgin surgery. It just depends on your insurance and how they interpret this surgery. Some also have a once per lifetime clause and it doesn't matter whether they were your insurance on the first one or not. Other people who don't have the clause and apply sail right thru, it's just so hard to tell. As long as there isn't a bariatric exclusion you should be able to appeal and eventually win. Good luck to you!
