band to sleeve revision with anthem blue cross blue shield of CT

fdematteo
on 1/3/13 10:41 am - East Haven, CT

Hi,

I need to convert from the band to sleeve.  I've done well, but my body is rejecting the band.  Has anyone had BC/BS cover the revision if your BMI is less than 30.  The waiting to hear from the insurance company is killing me.

Thanks

kcb0313
on 8/27/13 3:44 am

hello...wondering what happened with your situation. i am dealing with something very similar right now have bc/bs. any insight would be great!

fdematteo
on 8/29/13 6:47 am - East Haven, CT

I'm happy to say that after a level 2 appeal, Anthem overturned their decision.  They agreed that my revision was medically necessary.  I had to hire Walter Lindstrum who is an attorney who specializes in bariatric surgery.  In the end, I'm going to have the gastric bypass with less intestine bypassed than they do in the regular procedure.  I have some scar tissue from the band and didn't want to risk the severe reflux with the sleeve.  The surgeon was also convinced that I would eat too much with the sleeve because it is so much larger than the pouch.

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