Revision surgery and Aetna Insurance

Has anyone ever been denied coverage for revision from VBG to RNY by Aetna Insurance? I was denied last week for lack of documentation to prove medical necessity. I am in the process of appealing right now. Any help or suggestions would be appreciated.

Hi Angela... PLEAASE keep me posted on your situation.. I am also trying to get a revision from VBG to RNY.....my doctor (who has worked with Aetna as a review doctor) tole me that as long as I had "proof" of a breech in the staple line, then it would be considered a mechanical break down and it would be covered. I had an Upper GI done this past Friday and my staples are GONE!!! So, she says that is the only documentation that is needed and Aetna should approve the "repair/revison" surgery for the RNY.. this is link to Aetna's policy page.... my info should be submitted by the end of this week, or some time next week, once the X-Rays are sent over to my surgeon's office..... What is your BMI, do you have an co-morbities. Is your staple line undone???...I have severe high blood pressure and my BMI now is about 41.2 or 42.... Good Luck http://www.aetna.com/cpb/data/CPBA0157.html

I just wanted to update and let everyone know that Aetna approved my appeal for revision to RNY. You just have to keep trying!