Am I eligible for a revision?
i had VSG in 2014. I lost 85 lbs in the first 11 months, plateaued for the next year then began a regain last year and have regained 25 lbs. I continue to track what I eat, get my protein in and exercise but it doesn't matter what I do, I can't lose the regain, and never got to my goal weight to begin with. I have been seeing a weight management dr for the past year on and off and have lost and gained the same 10 lbs. my question is, should I pursue a revision...and will insurance pay again? Or just be thankful I'm 85 lbs down? The restriction is still there but I guess my body has found a way to survive on fewer calories.
high weight 283, surgery weight 265 (after liquid diet). Low weight 180. Current weight 205. 5'5"
my goal was to get down to 150 but I never got there.
First, have you scheduled an appointment to see your WLS team to discuss the issues? Only your surgeon can determine if you are a candidate. Do you have other issues going on? GERD? Hernia?
What is your daily caloric intake? What are you eating? You stated that you track your food and exercise which is great.
Generally, insurances will pay if there is an issue such as GERD or issues with the original surgery. I had a revision from VSG to RNY due to bile reflux and a hiatal hernia. My insurance did cover the revision. I do feel better and I am losing the weight gain.
So, go see your surgeon and get checked out.
Try posting on the main boards & go to the What are you eating threads on the VSG & RNY forums. I eat little is a little warped for people like us. My eyes were always bigger than my stomach. lol Ask for tips, post your menu. Chances are that it needs tweaking.
No one surgery is better than the other, what works for one may not work for another.
T-Rebel
I don't think you'll qualify for a revision unless there was something wrong with your sleeve. Get checked out by your Dr that everything is ok in there.
It looks like you're a lightweight & so it might take longer to get the weight off, you didn't have much to lose to begin with. Stalls are normal
When I was working my way down, often I had to change up my calorie, carb & protein ratios, plus I upped my water.
Look at the What are you eating threads on the VSG & RNY forums. You might have to cut back & change up what you're eating to get going again.
No one surgery is better than the other, what works for one may not work for another. T-Rebel
Hi there. I have BCBS Federal also. I saw all the typical requirements for surgery, but when looking for a subsequent bariatric surgery there are additional requirements. I'm worried about the requirement - lost less than 50% of excess body weight with the first surgery. I did lose a lot (started at 378...got down to 193...now I'm back at 300). I'm trying to figure out what information the doctor has to send in to get me approved for a revision. Do they have to send in ALL notes from the last 9 years since my surgery, or just focus on my current weight and struggle? I just don't want that one thing to exclude me.
Did you talk to an insurance representative? There are several items that have to be met, just like with our first surgery: Psychological approval, 3 month supervised diet, been obese for at least 2 years, don't smoke etc.
So any information you have that may help me with BCBS Federal, please send my way.
Thank you!
Jen
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? Benefits for subsequent surgery for morbid obesity, performed on an inpatient or outpatient basis, are subject to the following additional pre-surgical requirements: â?' All criteria listed above for the initial procedure must be met again â?' Previous surgery for morbid obesity was at least 2 years prior to repeat procedure â?' Weight loss from the initial procedure was less than 50% of the member's excess body weight at the time of the initial procedure â?' Member complied with previously prescribed post-operative nutrition and exercise program â?' Claims for the surgical treatment of morbid obesity must include documentation from the member's provider(s) that |
Hi
Initially when I was thinking about a revision and talked to a representative the only thing she wanted was a supervised diet for 3 months. Fast forward this year, they are asking for psychological evaluations and other requirements. I don't think the 50% weight will have any baring on the insurance decision. It's all in how the doctor word medical documentation upon requesting a revision
