Advice
Hi! I'm new here. Here is my story...12/31/08, I had lapband surgery. I lost about 70 pounds total. I had a lot of problems with the band with restrictions; it was either too tight, or not tight enough. I went through that for about 2 years. In 2010, I moved away from the city I had surgery in to attend college. Because I didn't have insurance anymore, in order to keep getting fills, I would have to pay $100 OOP at a surgeon's office in the city I had move to, or travel about 2 hours back home for adjustments. So, i have my surgeon's office take out some of the fluid because I know I wouldn't be able to travel back often. I got a personal trainer, went to the gym and nothing! The only time I lost more weight, is when I took HCG. Now, let's fast forward to 2018. I am currently trying to get revision surgery; lapband to RNY. My insurance (BCBS) covers the surgery. I found a surgeon from their blue distinction list, did all of the requirements they asked for, and they denied me. I received my denial letter last week, and they denied me because they are claiming that I did not follow a nutrition and exercise program following the surgery. How can they prove that I did or didn't? I have gained over 100 pounds since surgery, and I have a "floating" port. No one can access the port. I have even stood in front of a x-Ray machine for a doctor to try and access back in 2015, and he couldn't, it kept moving. Last week, my doctor requested my follow-up visit records from my first surgeon and submitted for reconsideration. What are the chances of getting this approved? Has anyone gone through the denial process, and had it overturned?
OMG @ Floating port i myself am having revision surgery tomorrow and i have health1st as my insurance carrier not sure why they would deny your situation as im reading it you sound like a approval case in my book i had the RNY in 2009 done laparoscopic and im having a revision called the "Distal Roux-en-Y gastric bypass" i went thur the 6 months to a year criteria excercise, rx weightloss pills, diet as well as the presurgery testing sono's,physc eval cardio testing ... etc submitted to insurance on 8/30/18 and got approval this week. i would contact the insurance and get a copy of a more detailed description of the denial and what is was based on and also compare it to the criteria for the revision in the plan contract/handbook if they have any due to the unique situation of the floating port and if if the denial still stands then what are the guidlines to rectify the floating port .
