DS Revision Insurance questions

angie00708
on 1/10/12 5:30 am, edited 1/10/12 6:43 am - College Station, TX
I have BCBS/TX and it covered my RNY 2.5 years ago, no problem. I was not successful - never lost even 100 lbs. being completely compliant with diet and exercise. I'm looking at a revision to a DS but there is a clause for DS in the policy that says you have to have a BMI of 50 or greater for a DS (only 40 for RNY w/ no comorbidities). My current BMI is 41. My questions is - has anyone been successful with appealing a denial for something like this? The DS would be much better for me - the surgeon even thinks so and is willing to write a letter stating such. Is it worth the time it's going to take to fight this?


 

(deactivated member)
on 1/12/12 5:25 am
Well, * I * think it would be worth it to fight.

Appeals for exactly this have been successful but the person that is the expert is no longer here.

My signature line is where she is at these days.
Barb H.
on 1/13/12 3:16 pm - Kailua-Kona, HI
Revision on 01/25/12
I also think its worth the time to appeal. I'm revising from the band to RNY and was able to bypass the pre-op six month stuff because it is a revision. Documentation from my PCP plus the surgeon and the weight loss clinic where I go and I was approved in about a week.

Go for it!
Lap band 03/09; revised to RNY 01/12
Read about my journey at www.journeyofafatwoman.wordpress.com
   
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