Question:
How do I seek a revision?

Am I doing this right. I made an appt with gastroenterologist but it is not till October. SHould i contact insurance company first about revision or do it this way and then ask. My insurance is choice care select and it does have an exclusion for all weight loss surgeries excepy VBG. Found this in the book. I had an RNY in September 99. Not sure which way to go and need help    — snicklefritz (posted on August 21, 2002)

August 21, 2002
Yikes..this isnt about weight loss surgery, its about being medically necessary. You need to find out who your preferred providers are and start there. If you hav an exclusion to "weight loss surgery" things can be worded in a way that indicate the medical need. example...a woman gets a breast augmentation...implants..never covered unless she has had a mastectomy. Goes home and 2 days later develops a rip roaring infection and is admitted for 7 days...that has to be covered because it is medically necessary, even if the origional surgery was paid for out of pocket....be persistant and find a good doc that knows the insurance game....I worked for an insurance company ( I am an RN ) and it really is a game of semantics > GOOD LUCK
   — Keniki B.

August 22, 2002
The first thing to do is to have someone do the testing to determine that a revision is in order and whether or not your pouch has stretched or if you have a "mechanical failure" such as a ruptured staple line. I had my revision from VBG to RNY and the insurance company fought it saying they pay for only one weight loss surgery, period. My appeal was based on the fact that I had a mechanical failure (my ring at the bottom of my pouch disappeared) which rendered my original surgery useless. It took months but they finally approved it. Find out what your insides look like and then book a consultation with a doctor who does revisions and then go from there is my opinion. Hope this helps. If you have any other questions, feel free to e-mail me at [email protected]. Good luck!
   — Kellye C.