Question about BCBS Federal - Lightweight BMI 35 with co-morbodities.

I'm in the process of getting a revision from the Sleeve to the RNY. I have a huge hiatal hernia and severe acid reflux.

Did your surgeon turn in your BMI of your first visit or did they turn in the BMI of your last visit after being on your required 90 day multidisciplinary nutrition program? I already posted this question on the Insurance and the Revision Forum but have received a few replies. Please share if you can.

Thanks.

I revised from sleeve to VSG in July, 2016. I can't speak to your particular insurance requirement, but my approval was not dependent on BMI. I revised because I had a post WLS diagnosis of severe GERD/Reflux. Because I wasn't revising for weight loss purposes, my BMI was irrelevant. I was approved based solely on my DeMeester score and the damage to my esophagus.

Also, I wasn't required by my insurance or my surgeon to have a waiting period. He did ask that I attend the pre-op meeting/post -op meeting because, as he said, "everyone can use a refresher."

Sorry I couldn't be more help.

That makes sense. I believe that is what my surgeon is going to do diagnose me of having severe GERD/Reflux. Mine is also post WLS. Well I guess I have to continue to jump through more hoops before they turn in the request to my insurance. Thanks for sharing again stacyrg! You rock!!! With your WL!!!

Hi,

I am a revision as well. My surgeon did not use a bariatric procedure code rather a stomach fusion/bowel code of some sort to revise my surgery based on medical necessity. I had a hernia and GERD for 9 years with the sleeve. I did not have a nutrition program to deal with. Thank goodness. But I did have to meet with the shrink and dietician over the phone but this was not a requirement of my insurance company.

So, your insurance allowed your surgeon to fix your stomach problem and do the RNY? That what my surgeon is going to try to do as well I believe. I just don't know why BCBS wants me to do the nutrition program, etc... Oh well, I will do whatever it takes. Thanks so much for replying!!! You Rock babs!!!

Hi,

Yes, I didn't have to do a program. My surgeon used a procedure code that is stomach and bowel related. However since the medical facility was trying to get their COE, they required I fill out a psych form, have an evaluation ( my surgeons husband is the shrink and had RNY) and the dietician call which was over the phone because I was from out of state. I had a two night hospital stay.

Ok, that is great. I will have to see what happens.

Thanks again!