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Every insurance company and plan is different, so none of us can know what your plan covers. Call the customer service number on the back of your card to ask them.
If your plan has a "one surgery rule" and no coverage for "medically necessary" revisions, you're likely out of luck. You can look into self-pay for a revision surgery, including lower-cost options in Mexico.
What type of revision would you want? There's not much of anywhere to go with an RNY without running into some pretty serious risks. Some people have had their stoma stitched more tightly, but that doesn't often result in much weight loss.
You can also try going back to basics-- logging food, limiting calories and carbs-- to use the pouch that you already have.
Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!
I had a gastric bypass in 2009 (starting weight was 330 and lost down to 150). 10 years later and several illnesses as well as chronic pain (and let's face it... LIFE) and I'm almost 30 pounds heavier than my surgery sw.
Question: I had CareFirst for my original surgery. I am now with TriCare Select. Does anyone know if TriCare would cover the revision even though they have a "1 surgery rule"?
I have a consult with a surgeon (I'm in Augusta, GA) and they are going to do the legwork on the insurance; however, I'm trying to find out if someone has had this situation before I get my hopes up.
Any help would be greatly appreciated.
This is me EXACTLY!!!!!!! I have gone year after year to get denied. I am NOT giving up this time and taking it as far as I have to.
Thank you for giving me hope!
I would work with your surgeon's office and getting them to make the case that the revision is medically necessary. They really need to know all of the side effects and complications you're experiencing ****pt a list on my phone since it was easy to forget about all the little things I have just learned to live with over the years that were not normal). Make sure they understand how miserable you are, how it's affecting your life, emphasize how your current tool isn't working as designed and that you need a solution to the issues and complications you are experiencing. They should be your advocate and help with your insurance company.
I had the same insurance requirement and I had similar issues with frequent stuck, vomiting and GERD. Year after year I would go in and they would run tests, confirm I didn't have a slip or any mechanical issues so I figured there was no chance to revise. I finally gave up and had just had them empty my band, even though that did not resolve my issues. I went back after 3 years since I was still having issues stuck issues daily and really pushed for them to help me. I made it clear I wasn't going anywhere and that I wasn't going to just deal with these issues for the rest of my life. They helped me pursue a revision and when my insurance initially denied it they did a "peer to peer" with my insurance company and it got approved.
Good Luck!
Band to RNY 8/16/18
Age: 33, Height: 5'4"
HW: 299 (Pre-LB), RNY Consult: 260, SW: 248, GW: 145 (reached 3/31), New Goal: 130, CW: 133.0
Pre-op: -13, M1: -20, M2: -15, M3: -15, M4: -15, M5: -13, M6: -13, M7: -9, M8: -9, M9: -3, M10:
Thank you very much for your feedback this is what I was looking for!
I've elected not to move forward until I research a little bit more.
Again, thank you so much for your valuable feedback!
Felecia
on 6/10/19 3:42 pm - WI
The procedure you are describing is a Distal RNY. There are lots of studies about this revision online.
You may lose weight with this revision, but many people have issues with chronic diarrhea and vitamin deficiency from malabsorption.
If you go through with this surgery you will need to be hyper-vigilant with taking your vitamins and having frequent blood work.
HW 270 SW 236 GW 160 CW 145 (15 pounds below goal!)
VBG Aug. 7, 1986, Revised to RNY Nov. 18, 2010
If you don't know if this is "OK," you need to have a conversation with your surgeon ASAP, or get a second opinion.
They should be able to talk to you about potential side effects as well.
Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!
Several people on here had good experiences with Lindstrom.
https://wlsappeals.com/
This might give you a start if you are trying to do it on your own
Real life begins where your comfort zone ends
I'm having a laparoscopic revision of the gastrojejunostomy with lengthening the intestine from 5 feet to 15 feet.
Just curious if this is ok and if anyone share there progress if you had this procedure done.
My concern is lengthening the intestinal to 15 feet and what side affects this could present.
Hi Everyone,
I had my lap band placed 12 years ago. I've been trying to get it removed for the last five for various reasons such as frequent vomiting, GERD etc. My insurance DOES have a once in a lifetime clause HOWEVER it will revise if medically necessary.
Until now, I have never appealed the denials. I am currently fed up and can't go on much long. I never gained all of my weight back but my BMI is 37 with these co morbidities:
Morbid obesity
Gastroesophageal reflux disease
Multiple joint pain
Depressive disorder
Benign essential hypertension
Anybody have a similar experience. I could use some advice with the appeal process too because I'm not giving up this time. I have BC/Bs Personal Choice (PA)
