VSG to DS

A little background info on me.  Had VSG in 2009, lost 110lbs in 6 months!  Felt great!  Still had another 40lbs to go!  At least!  By the time I hit my 1 year anniversary I had already started to gain back some of my weight.  I've yo-yo'd for the last 5 years.  I'll put the on 10-15lbs and then take it back off.  Well now I've put back on 55 of the original 110lbs!  I'm struggling to take anything more than 5lbs off now!  I feel very discouraged!  Anyways, I'm thinking about getting DS now.  (or step 2 as my doctor called it)  My insurance states they cover DS and they are sending me info on the criteria I need to meet to have surgery.  My question is, since I already had VSG do I still have to meet all the same criteria I did when I first had surgery?  I have BCBS of Michigan.  Does BCBS usually cover revisions?  Would this actually be considered a revision?  Any insight or info would be greatly appreciated!  

I think most insurance companies would still call it a revision. It sounds like your Doctor is on the right page by calling it the 2nd half of the DS. I think they will try and make you meet the criteria again but if that happens I would ask your Doc to appeal it based on it being the second step.

If your VSG was authorized as a VSG and not as the first stage of a 2 stage DS, I suspect your insurer will look at the next operation as a revision. As to whether or not you have coverage for a revision, and what criteria are necessary for coverage, that depends on your policy. There are many different policies out there. You need to get your EOC (evidence of coverage) and read the specifics for yourself. This is a lengthy document, not a brief summary. And don't trust some low level employee over the phone to get it right for you. You need to be proactive and read the actual coverage details yourself.

You may also need to learn what your appeals right are as denials of coverage for revisions are very common. And most of all, you should know that we are seeing new people looking to revise from both lap band and VSG to DS all the time. You are not alone.

Larra

Same boat as you, except I ended up having a DS revision afterall.  It did nothing for me, in fact I have gained 30 pounds since. It is being investigated now. Who knows why this is a complete failure, but it was. No I do not eat chips and shakes all day. Good luck.