Question:
insurance / 6 months of dr visits b4 bypass-need emergency surgery now

have haitel hernia where stomach has pushed thru abdomen and now sits in chest. Dr wants to preform rny Gastric bypass to correct hernia and to keep the weight off after BMI 41.5 Insurance has us in bariactric red tape that says all bariactric surgeries must have monthly dr visits to see weight over 6 months... anyone heard of this???    — Terry W. (posted on February 10, 2010)

February 10, 2010
Most insurance companies require at least 6 months of monitored weight loss program. Some only require 3 months. Its not just about the surgery. There are many things that need to be done before the surgery. You may have to see a cardiologist, pulmonologist, psychiatrist as well as go through a lot of blood work. The insurance companies try to make sure it is necessary as well as wanted. I had to go through 6 months plus all the doctors. I am still waiting approval. Its good to do a lot of research and make sure which surgery is best for you. This is a total life change. Don't jump into it.
   — Hilkerrt

February 10, 2010
Aside from this being a medically necessary surgery, I would think the insurance company wouldn't look at it as the "normal" gatric bypass. You have a major issue with the stomach that needs repairing and the only way to fix it is the rny. So I would fight with the insurance company and tell them it isn't about the 6 month diet; that you have an issue that requires this type of treatment. Perhaps there is a medical code they can use to get this approved but showing necessity of the hernia. I have not read a post on here at all like this. See if there is another medical code to enter is all I can say, and don't give up. They want to argue small issues like a 6 month diet but your issue isn't just needing the rny, you have a hernia that needs repairing. Best wishes to you.
   — Kristy

February 11, 2010
Your doctor should be coding this as a needed repair for the hernia. But I hate to see someone who has not prepared do this surgery. It is a major life change and you need to understand that before you go through it. I hope you can get the insurance to resolve things. It is a pain how they set things up but there really are reasons why. People who do the surgery without the right mind set tend to put the weight back on at a year or so out.
   — trible

February 11, 2010
I too had a very painful Hiatal hernia, and I too had to wait the full 6 months for my surgery! I found that while a hiatal hernia is painful it is not life-threatening and therefore could wait for the surgery. I took meds and did alot of diet changes 'before' my surgery, and I survived. I am down a total of 126#, maintaining since last July, and I'm off all my meds now. I never thought I would get into a size 8 again. LOL* You will be okay, needamiracle.
   — BeenThere1

February 11, 2010
When the surgeon was doing my LAP/RNY he discovered I had a hernia. I had to come back at a later date to have the hernia repair surgery done. From what I was told, unless the hernia is strangulating it is not life threatening. I've never heard of an insurance company lifting bariatric surgery requirements which are more than just a six month diet as a writer above mentioned.
   — Muggs

February 11, 2010
Insurance companies do that, but your doctor can send paperwork, have you ever been on weight watchers or anything like that, that would have documents showing you were on a program....
   — MarthaJ0110

February 11, 2010
thank you all. Just a note years ago I actually had researched gastric bypass and because at that time I was not morbidly obese I was not covered by previous insurance. I have re researched gastric and haital hernia(also considered a very serious surgery) and can see my Dr. reasoning for this procedure due to my weight and due to the fact both sugeries present change to my life and a portion of my stomach used or removed. I would however love to follow thru with what he feels is best and after careful study I now agree. Its the insurance we now have to contend with and I wonder for how long my stomach can sit in my chest cavity upside down without strangulating.. thats why I wrote need a miracle.
   — Terry W.

February 11, 2010
If you can establish that you were weighed in at a doctor's office for a six month period and were on a diet, that should satisfy the requirement. It did for me without having to wait another six months. My surgery was paid by medicaid. Hope this helps. It's governmental BS from the dark ages of GBS.
   — Dusty Ray Vaughn

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