Revision and Insurance - Did Insurance Pay for Revision

Did any of you that had a revision have challenges with getting your insurance company to approve your surgery? I had a staple line breakdown in April 05 and insurance wants to see documentation that I was compliant and medically supervised in my diet from original SRVG surgery in 2002. My hospital still has my files and they went bankrupt and I can not access my bariatric folder. However, I have Dr. Distlear, who performed my first surgery. He will be doing the revision. Have any of you had problems with getting approved and how long did it take and what did you have to do. My doctor did inform me that the weight loss would be slower. I dont necessarily mind that as long as I can loose again. Plus I really dont want anyone to know that I had a revision and it wont show as fast as my first surgery.

Hi, I'm having a problem having insurance cover my revision. My surgery was in 2002 and I lost 168 pounds. I've gained 45 back. Horizon denied it because my BMI is not high enough. They feel it is not medically necessary. They also want to know why it failed. I'm in the process of appealing. In my case I qualify. The woman from Horizon admitted she screwed up my approval. Instead of correcting it she just denied it. When they review they will see I qualify. Our lives are truly in their hands. I also need major back surgery. I'm hoping they will see that I need the revision first. I never in my life thought I would have to fight and insurance company when a Dr. told me I need surgery. Always took for granted that it would be done. Good luck with your surgery.

I am fighting my insurance company to approve my revision. I was cleared for revision sugery and scheduled March 10, 2005. I had vertical banded gastroplasty June on 1996. My pouch is no longer in tact and I have gained the weight back. I have severe reflux and sleep apnea. My insurance company denied payment for the revision. They claim because WLS should be done once in a life time that I am a risk of again regaining the weight . They also claim there was no documented failed attempt at a medically supervised weight loss program and now I am at Weigh****chers for 6 months as my insurance company stalls payment. They also claim I was non compliant with the nutritionist although she cleared me for surgery. I appealed and they denied. I am in the process of collecting a number of letters from my many specialists to prove my co-morbidities and plan on resubmitting after the 6 months is up with W.W. My gastroenterologist has advised me to turn them into the state insurance commission if they deny payment as my revision is medically necessary and my BMI qualifies me. FINGERS CROSSED !

Very interesting. My insurance company recently denied me again stating that I did not follow the nutritional requirements during my first bariactric surgery - EVEN WITH my nutritionist writing a letter. We are in the appeal process with letters and documentation to support that this was a mechanical breakdown of the surgery ; not due to non compliance. I am also beginning to prepare a letter to explain my side of the story. Just the same stall tactics... which isnt fair ... as we pay them a premium for them to cover US. Good luck

Keep fighting. I just won my appeal. I put alot of work into it. They denied because not medically necessary. They wanted to know why it failed. Everyone said I wrote an excellent appeal letter. I bombarded them with paperwork and filed a complaint with the state of NJ against them. My appeal was done in less then a week.

Kathy, Congratulations- I sent you an email to see if I may be able to see your appeal letter so that I can continue to build mine. I would appreciate any help. Did your doctor or anyone else write a letter also that went to the appeals board. What did your copmlaint to the state of NJ state and did the insurance company know that you filed a complaint. Please advise. Thanks and again, congratulations.