BCBS Fed Employee Insurance

In 2014, I tried to get a revision surgery from the Sleeve to the RNY. I was denied. This Thursday I have an appointment to talk to the surgeon (different doctor) about getting started with the whole process to get this done. I do have a Hiatal Hernia and my food comes up at night.

Was wondering if anyone out there with BCBS Fed Insurance was denied approval for their revision surgery and then after appealing or a Peer to Peer Meeting of the your doctor and the doctors at BCBS Fed getting the revision approved? Please share with me if you can.

Thanks.

I have Fed BCBS and had a RNY about 9 years ago. I did great for a long time but the last 3 years I've steadily been gaining. I want to have a revision but I'm not even sure what they can do. Someone mentioned an overstitch.

II just wanted to know what reason they gave for the denial? Insurance companies are frustrating.

Good luck wih your next attempt! I hope they say yes ?.

jJen

Hi ohiomomx2,

The reason for the denial was the medical information provided indicates non-compliance with prior 2 gastric restrictive surgeries a prescribed nutrition and exercise program following the original procedure. I asked BCBS what my medical information had they said the doctor's report on my first visit with the surgeon who did my Sleeve stated that I ate ice cream, which I told him I did that maybe a couple of times so they considered that non compliance. BCBS Fed didn't even cover my Sleeve I was self pay $$$. The surgery (LB) I had before the Sleeve in 2008 BCBS Fed did cover it.

On this forum, I have been judged and picked on because of my past failures. Please be kind. Thanks :)

LB - 2008

Sleeve - 2009

Thanks for replying to me.

Thank you for the information. If people are saying anything negative to you they are hypocrites. I just don't get why people say the things they do.

I just saw that you had the same insurance as me so I wondered what information they gave for the denial. I had the RNY in 2008 and BCBS Fed did pay for it. Now my weight is coming back on and I know I have to do something drastic or I'll be right back where I was in 2008.

When I read the benefits section for a subsequent bariatric surgery there was one requirement that I don't believe I meet. I'm tall (6'3) and highest weight was 378. I got down to 193. I have NO idea what they listed as my ideal/normal weight should have been, but I'm sure I exceeded the 50% mark. I pray there's a way to get around that. I'll work with my doctor to see what information to send in, maybe the docs don't have to submit every little bit of information from the last 9 years.

I've been really lucky with BCBS Fed covering anything I've wanted/needed done, but I'm really worried that 50% mark is gonna knock me out for a revision.

I'm not even sure what revision is possible for me since I had the RNY....

Anyway, thanks for the information about your situation. If you have any suggestions/advice for me I'm all ears!!

Thanks,

Jen

Thanks for your kindness and reply. I hope & pray your good fortune continues with BCBS Federal and you get your revision!!! Keep in touch!