Sleeve Revision Concerns

Hello everyone. It's been quite a while since I've posted on the site. I had the sleeve done in 2011 and was doing pretty well with it losing about 60 lbs until I was about a year and a half out, I started putting the weight back on and also now have reflux pretty bad. I've regained about half the weight I had lost and am extremely frustrated. I have an appointment with the WLS in a couple days to talk to her about a revision. From what I've read the DS is the way to go. My insurance company is Cigna and I am wondering if they will look at my BMI and not approve me due my not being morbidly obese. If there is anyone out there who could shed some light on my concerns, I'd greatly appreciate it.

Hi Snakedavisjr,

Each insurance company has different rules in place regarding WLS, whether revisions are covered, and if there is a minimum BMI for them. You can request a copy of your Evidence of Coverage from your insurance. This should outline exactly what the requirements are for surgery in your own policy.

For my own insurance, they required a BMI of 50 or higher for the DS but again, each insurance policy is different.

Best of luck to you!

Thanks for the reply Felicity. I just checked Cigna's policy and it does say that they do cover revision surgery when certain criteria is met, one being that a certain percentage of weight loss was not met. Thanks again. I'll see what the doc says tomorrow.

Good Luck with Cigna. I fought them for a year to get my band out and revise to the bypass.

As for the DS they require a 50bmi or higher and unless you get something in writing from Cigna that they will do a revision to the DS with a low bmi you very well maybe out of out luck.

Be ready to be told NO. Especially if the only reason for the revision is weight gain. They will want to see a full history from when you got the sleeve to now. If anything shows you did not follow the plan they will deny you. For me I had enough proof that there was something wrong with my band. The first 7 years showed full compliance and great weight loss. I started having issues with food getting stuck and heartburn. Had all the fill removed and still continued to have heartburn/reflux/food stuck. Even with the proof there was something wrong I still had to fight them.

Sorry to sound like a downer, but I would rather you be prepared then blindsided. Oh yea and so far I have over 5K in bills to pay since Cigna won't pay for everything. I was told I would have to pay a $250 hospital copay and $500 doctor's copay. Yea that was a lie.