Question:
Anyone have insurance problems related to approval of a revision?
I had my original WLS in 1998 and am in need of a revision. I lost 125 pounds, but have gained 70 of it back. My doctor has agreed to this revision; however, BCBS has denied my first request. My BMI is 35.5, apparently not high enough. I do not want to have to gain more weight to truly be morbidly obese. I feel that my co-morbid conditions and prior history being morbidly obese should indicate the need for this new WLS. If anyone else has walked down this path, I would truly appreciate hearing from you. Thanks — Cindy H. (posted on March 5, 2003)
March 5, 2003
— ellton
March 5, 2003
The issue with BCBS might actually be that your surgeon wants to do more
than a 100cm bypass in the revision. BCBS does not like what they call
long limb RNY's, which in their book is longer than 100cm. The 35.5 BMI
without significant co-morbs is the other major issue. Good Luck!
— zoedogcbr
March 5, 2003
I only regained 12#, but had successfully kept off 100# before my staple
line disrupted. The only expense to my ins company is routein labs &
such to keep me healthy,. NOTHING like when I was full sized. My doc wrote
a beuatiful letter listing my comorbs (think $$$$ for weekly visits) and
assuring them that regain WOULD happen, not "might". The ins
looked at it as a "repair" to a working surgery & poof, it
was done. I thought it was a miracle. I've seen many get approval to
change surgery types based on insufficient wt loss (or regain), but of
course, they all had different insurance types.
— vitalady
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