Is there anyone out there insured with BCBS Federal that was non-compliant with their weight...

Hello,

In 2008 I had the Lap Band surgery. BCBS Federal approved the surgery. The doctor also repaired a hiatal hernia that I had. The heartburn that I used have got worse with the LB. I lost 17 lbs. and gained 13 lbs.

In 2009 I decided I wanted to get a revision surgery from the LB to the VSG. I found a surgeon and went to see him for my initial appointment. He asked me what type of food I ate. I told him what I ate. He asked me if I cheated I said sometimes I would eat white carbs and ice cream. BCBS Federal did not cover the VSG at that time because it was still considered experimental. So, I did the self-pay. I had the surgery, he removed the LB did the VSG he told me he repaired the hiatal hernia too. I had some very stressful things going on in my life which led to more depression and I turned to back to the wrong food for comfort. So I began to gain the weight I lost which was 30 lbs. My acid reflux became worse. This surgeon never told me that a VSG would make my acid reflux worse.

In 2014, I went to see another surgeon about getting a revision from the VSG to RNY. When the office turned in the request to BCBS Federal they denied it. There reason was because I was non-compliant with 2 prior surgeries and my medical records indicating that I ate the wrong foods. (VSG surgeon notes on my record, patient ate white carbs and ice cream).

Now in 2017, I am trying it again with BCBS Federal to be revised from the VSG to the "Gold Standard" RNY.

Is there anyone out there insured with BCBS Federal that was non-compliant with their weight loss surgery and got approved for their revision because of GERD?

This will be my 3^rd surgery, but it would be the 2^nd as far as BCBS Federal would cover, since I did self-pay for the VSG in 2009.

I have BCBS Federal and just had my Lap Band to VSG surgery. Get a good bariatric physician who has done this surgery more than 50 times. Jump through all the hoops their practice asked you to do. Every band person is at some point non-compliant, just don't make that a big deal. It took me 2 years to get to my surgery date, but I am so happy I did. I haven't felt this good in years. I had the band 10 years and never found my sweet spot. Now, I am satisfied with very little food and the weight is coming off. Hope this info was helpful. Best of luck to you.

Congrats on your revision. VSG was not a good surgery for me though, cause of the acid reflux. I have picked a very good bariatric surgeon I'm sure she has done many revisions. My only concern is bcbs fed not approving my revision. Yes, your information is helpful to me. Thanks for replying. Best wishes to you on your weight loss journey.

My revision was at first denied.Then my Dr did a Per to Peer with Insurance and helped them understand it was for acid reflux issues not failed sleeve.I lost I had lost 80 lbs but had put on 20 more.Since my revision in 2016 I have lost another 50 lbs.

GmaDiane, Thanks so much for sharing. I am afraid that they will deny it since they denied it before. I will suggest the Peer to Peer to my doctor. That is a good weight loss 50 lbs. They say it's harder to lose when it's your 2nd WLS.

Did you have a Haital Hernia too?

Yes I did have Hiatal hernia repair again with the second surgery.I'm trying to keep up some exercise program to help get more off.

You can call lindstrom obesity advocates and they are super at telling you if you have a case or not !

Hi Sheri, Thanks so much for replying and sharing the information on the lawyers. You are doing so great on your weight loss!!!