So I just got back from 1-month check in for my 6-month diet I am doing in case my insurance requires it in order to be approved for a revision.  And to be honest I am kinda bummed.  My PCP tried to tell me that if I eat 1200 cal/daily & walk for 30 mins 5 times/week I can lose a pound a day?!?!?  I didn't want to correct him and maybe he meant a pound a week.  But then he goes on to say that I dont think your insurance will approved this surgery a second because they only want to pay for one surgery of this nature.  Totally bummed me out!!  The bariatric office I am being seen in repeatedly has told me that my insurance (Medicaid) does pay for revisions its just they likely will require a 6-month supervised diet, even if the pouch & stoma are found to be dilated (which mine were found to be in such a condition).  I am trying not to give up but it would really crush me to do all this to get denied.  Anyway, I think I will see another PCP in my doctor's office at my next visit because its really important that I get the support I need from whomever is guiding me on this supervised diet thing.  Maybe I am being too sensitive?  Anyway, just needed to vent..thanks OH Fam!

Medicaid paid for my revision

Hey Gina,

 

could you tell me a little bit more about your experience with medicaid and your revision?  Like under what cir****tances did they approve it and were you required to do anything like sleep study, supervised diet, ect.?  I know each state's Medicaid are different, but just curious as to how it worked out for u?  

 

Thanks,

   Tonya

Your BMI has to be 35 with comorbidities or 40 without. It must be medically necessary. Try to keep some sort of record of weight loss attempts.  Make a spread sheet,  Show some sort of weekly weigh ins what you did, what you ate and exercise. I was denied for being non-copliant.  Then when I produced the spread sheet, I was approved. I wrote a letter and had my PCP sign it stating that it was medically necessary. Im not sure if I still have the letter. I have Hashimotos disease and I also had a letter from my endocronologist stating it was medically necessary.   When I check my other computer, I will send it to you if you want.  Be well prepared. 

Yea, that would be great.  I started a 6-month supervised diet with my PCP last month so I'll have that documentation.  Do you think I should make my own at home as well? 

I think they wanted to see 2 years of weight loss attempts.  I gave them a year(my own spread sheet)  Definately keep a record.  Better to be well prepared.

Hang in there, I would go with what the Bariatric department told you, they are experienced in this and deal with insurance plans daily.  Good luck!

Thanks Susan!  I appreciate your encouragement ;-)

Keep your head up!!
What kind of revision are you seeking? That doctor is wrong,... I tried that 30 min 1200 calorie deal not so much.

Well I originally have the Roux-En-Y but I am leaning towards a revision to the sleeve.  Ive watched your vids..did you just have a revision of your original surgery?