BCBS FEDERAL REVISION FROM VSG TO RNY

In the approval process of being Revised from VSG to RNY with BCBS FEDERAL. How long did it take to receive your approval? Did you also submit a letter of medical necessity from your PCP. Any helpful information you can share will be much appreciated.

I'm wondering the same. I'm in need of a revision..may I ask why your in need of a revision.and what did you tell the Dr. To get the ball rolling.

Tia.

Hi there. I'm having the revision due to severe GERD. My reflux has become unbearable. I'm petrified of having the bypass but unfortunately it appears to be the only option to relieve the GERD at this point. I also have gained weight so hoping to lose some weight as well but no guarantees. 

Interested in hearing more about this.

I have not been on this board in years, and need to update all of my info. I won't do it right now, but I will be starting the process of finding this out too. I have BCBS Federal, and will be going to a weight loss seminar to get things started over. I had Lap Band surgery in 2007, and I currently weigh more than I did when I had the surgery. I had complications with the band in 2011, severe GERD and some erosion in my esophagus from the GERD. After a few days in the hospital, meds and all the fluid was removed from my band, the symptoms went away. I opted not to get any more fills because I was afraid of GERD returning. In the meantime, having no restriction left me being able to eat what I want, and over the years I gained all of the weight back. :-(

Since my band has been in for almost 10 years, I suspect there will be scarring and I will have to do a revision in 2 surgeries. I'm ok with that. I would like to get the sleeve, and want to make sure my stomach can handle it.

Like you, I haven't been on this board in years. I had RNY in 2003. I too have Federal BCBS , had Aetna when I had the surgery. I weighed 365 lbs before surgery and lost about 190 lbs. A lot has happened in between and I need revision surgery. I need to find a surgeon and get the process started. Thank you for sharing your journey and for the information. I look forward to following your success story.

This is a copy & paste of the BCBS Federal benefit plan for 2017 pertaining to the approval requirements for Bariatric Surgery.

 

Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. The member must meet all requirements.

â?' Diagnosis of morbid obesity (as defined on page 70) for a period of 2 years prior to surgery

â?' Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 43 for our coverage of nutritional counseling services.)

â?' Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise

â?' Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective

â?' Psychological clearance of the member's ability to understand and adhere to the pre- and post-operative program, based on a psychological assessment performed by a licensed professional mental health practitioner (see page 101 for our payment levels for mental health services)

â?' Member has not smoked in the 6 months prior to surgery

â?' Member has not been treated for substance abuse for 1 year prior to surgery and there is no evidence of substance abuse during the 1-year period prior to surgery

Benefits for subsequent surgery for morbid obesity, performed on an inpatient or outpatient basis, are subject to the following additional pre-surgical requirements:

â?' All criteria listed above for the initial procedure must be met again

â?' Previous surgery for morbid obesity was at least 2 years prior to repeat procedure

â?' Weight loss from the initial procedure was less than 50% of the member's excess body weight at the time of the initial procedure

â?' Member complied with previously prescribed post-operative nutrition and exercise program

â?' Claims for the surgical treatment of morbid obesity must include documentation from the member's provider(s) that all pre-surgical requirements have been met

I attended a bariatric information session on 2/7 at Huntsville Hospital. I have an appointment on 2/15 to begin my monthly medically supervised weight loss program with my PCP, and an appointment on 2/21 to meet the surgeon. He spoke to the large group at the information session, so I will get to meet with him one on one to discuss everything with him, and my other required appointments (nutritional counseling and psychological clearance) will be scheduled after my appt with him.

I plan to contact every physician's office I have been treated at since my lap band and have them fax what they have on me to the bariatric surgeon's office. That will include the orthopedic surgeon who operated on my knee (obesity related cartilage damage), the hospital I was admitted to for the erosion, my previous bariatric surgeon (was contacted during my hospital stay, he removed the fluid from my band) the OB/GYN physician who perform my hysterectomy (and I'm still fat after having fibroids and a uterus removed the size of a 5 month pregnancy), the records from my sleep study physician (records showing I'm using my CPAP machine), copies from my past memberships at LA Fitness and Planet Fitness showing I was trying lose weight, letters of medical necessity from my PCP, the surgeon and I'm going to write one on my behalf as well. I want to make sure they have everything I can think of to send when it is time to submit my request to BCBS Federal for approval.

I weighed 277 on the day I had Lap Band surgery, I got down to 229 before I started having issues with it. Today, I weigh 288. :-(

I'm going to make sure I stress to them how painful it was having GERD. It started out as occasional burning, and progressively got worse. I was coughing a lot, seemed like I was always catching a chest cold. I ended up telling a friend of mine who is a nurse about the nausea and vomiting that had started, and what looked like coffee grounds coming up. She told me to go to the ER asap. I did and was in the hospital for 3 days. After the fluid was removed from my band, there's no way I was going back to get any more fills once my esophagus healed up. I did not want to experience that again.

I will make an effort to come back in here to give updates on my approval process. I sincerely hope BCBS Federal will allow me to get the help I need. I'm not sure if it will make a difference, but I do plan to mention that I had different health insurance (GEHA) at the time I got my Band, so this will not be the 2nd time that BCBS Federal is paying for me to have bariatric surgery. It probably doesn't matter, but I figure every bit of info I can give them won't hurt.

Hey there. Thanks a ton for your posts. Hoping everything goes very well for you. Our federal plan does cover medically necessary revisions. It's great you already know the guild lines and what they need to review your case for approval. That's very helpful on getting your approval. Keep us posted and I will do the same. 

Yes, I will do that. I had my first visit with my PCP last Wednesday, Feb 15. That is the start of my medically supervised diet. I have to see her 3 more times. After my 4th appointment (will be on May 17), the surgeon's office will submit my case to insurance for approval. I'm going to schedule my psych appt and will attend a nutrition class in April.