Overstitch revision after RNY and BCBS Federal

I've been away from the board for a long time but I am in need of some information again....

I looked through my insurance requirements for a subsequent bariatric surgery and it looks very doable in my situation. The one thing I am really concerned about is that I keep hearing that the Overstitch procedure is not covered by any insurance company. Has anyone else heard this or tried to get approved for the Overstitch procedure following the RNY? I'm very interested in hearing from someone that has BCBS Federal that needed a revision and chose the Overstitch procedure.

I just don't want to jump through all the hoops and have the doctor's office submit for approval if insurance companies say "we don't cover the Overstitch, under any cir****tances".

I even considered getting the ICD9/ICD10 code for the Overstitch to see if that would covered it IF I met all their requirements. Make sense?

Any and all advice, tips, suggestions etc. are welcome.

(Side note: I had the RNY in 2008 and lost a lot of weight, but I've gained 100 pounds back in the last 3-4 years)

Thanks!

Jen

Your best bet would be to call them directly. From what I found on-line they do not cover the overstitch.

A friend of mine had it done about two years ago she was a self-pay and only lost 20lbs. She has since gained that back and then some.

If I were you I would look at why you gained the weight back. Was it due to complications?

Hi, I am in the heathcare business and never heard of the overtich procuedure. Maybe cause its expermental and not approved to do unless you pay cash. Some surgeons make up their names for things and tweak procuedures. I would like to know what a overstich procedure is ?

This is what I found on-line for it. apollo overstitch

I called the company. It's been on the market over a year. No insurance company will pay for it. I am scared for your friend. We don't know the complication rate on a really new procedure. I had 2 doctors that I called and said they won't even do it. It's a ballon they put in your stomach. They put it in for 6 months and take it out. If you have 20 lbs to loose maybe it's okay. But happens after 6 months. People eat. I can see this could be a money maker as its cash pay or charge. But what happen if it breaks ? That scares me big time. I am glad I researched the product.

No she did not have the balloon that is a completely different thing. The overstitch is supposed to tighten the stoma and pouch.

https://loseweightcincy.com/overstitch-transoral-endoscopic- pouch-reduction-for-weight-gain-after-gastric-bypass/

That's what I found.

Ohiomomx2, maybe you can help me out. I had my RNY Gastric bypass 1/9/06. I am 5'2" and weighed 300 lbs. I have never had a problem with my pouch until last May. I saw my weigh-in surgeon, Dr. Colquitt and told him I was having trouble keeping food down, burping, and can't stand anything fastened around my waist. I usually average about 120, which I am comfortable with. I have gained almost 20 lbs. I found out I have a Hiatal Hernia. My pouch has slipped into my esophagus. The only thing I can keep down is miniture Reese cups and Gaderade, what is weird my sister had the same problem and eating in February. She didn't have or need weight loss surgery. But she said that was the only thing she too could keep down. But General Surgeon at the Nashville V. A. Medical Center says they can't do the surgery as I have had Bariactric bypass and need a revision. What is a revision? I have heard where those who had lap band had to end up down the road of having a revision to the Gastric bypass. But I have that, but what is a revision in regards to the gastric bypass?

I live in the Nashville area, and several of the Dr.'s are no longer doing the surgeries, one is backed up 4 months. This has already been 2 months, and still can't even get an appt. to see what can be done. My surgeon is on the other side of the State and prefers someone closer does my surgery due to all the traveling for follow-ups. I'm almost 64 years old and need to get this fixed asap.

Thanks, Kathy Newton

I have GEHA and the surgeon I am seeing does not do the Overstitch with insurance he does patient payment only at $3500 here at UTMB University of Texas. From all the research I have done the Overstitch is not really covered. All the test, post op and pre op are covered just not the procedure from what I am finding.