Is a revision of an old rny considered a fix on a pre-existing condition?

randy S.
on 4/28/11 1:42 am - brooklyn, NY
Is a revision  of an old rny considered a fix on a pre-existing condition?
Is there a cpt code for a revision for a gastric bypass that is not considered bariatric surgery?  Since a revision is a fix on a pre existing condition. Or am I just grabbing at straws???? 
Winnie_the_Pooh
on 4/28/11 1:58 am
How would a revision not be considered bariatric surgery? Pre-existing or not, it is a bariatric surgery.  Doesn't your insurance exclude bariatric surgery.  I don't see how that would work.

 Winnie

 

randy S.
on 4/28/11 2:17 am - brooklyn, NY
Your right I am just so upset I am trying to figure anything out.  Maybe I will calm down in a few days.  Meanwhile I see no way out of this exclusion clause.  I can not believe this is happening to me.  I hate the guy at bcbs who answered the phone in 2010 when i called to make sure I was covered for the revision and he said "yes".  I just took it for granted that he knew what he was talking about and went about getting the 6 month Dr supervised visits and all the other test bcbs required me to do to prove med necessary.  Which I was.  What irony that bcbs would pay for the surgery because the review came back and surgery was deemed med necessary but the exclusion prevents me from getting it.
Amy Farrah Fowler
on 4/28/11 2:40 am
 Is it possible that it actually WAS covered in 2010, when you talked to the guy on the phone, but the policy has changed since then? 

MANY of our policies are changing frequently with regard to WLS, and adding "once per lifetime" bs.

randy S.
on 4/28/11 3:17 am - brooklyn, NY
Nope, policy changed August 1 2009.  He gave me wrong info.
Susan S.
on 4/28/11 2:22 am - Roselle, NJ
Revision is by definition on a pre-existing condition. As I said yesterday a structural problem that was life threatening would likely be approved but a failed weight loss (which is how this would be classified) likely would not. Bariatric surgery does not come with any guarantee......and since the most significant variable in long term success is compliance with behavioral change most insurers won't touch it. Is your surgeon offering you any assistance in working the system? What else are you trying? Susan
Obesity Help Support Group Leader - The Woman Warrior
286/170/131 (starting/goal/current)
LBL - 10-30-08, brachioplasty/augmentation 2-26-09, medial thigh lift 3-16-09
Plastics - Dr. Joseph Fodero

 


286/170/140/131 (starting weight/goal/surgeons goal/current)

LBL 10-30-08 - Joseph Fodero
Brachioplasty/Breast Augmentation - 2=24-09


 

randy S.
on 4/28/11 3:13 am - brooklyn, NY
No Dr. is currently doing anything.  Dr Greenbaum pretty much out of picture since he only will do a revision to a distal bypass which the consensus is that it is basically the worst of both worlds and I should not do it.  Already fought that fight, he will not change his mind.
Dr K - I just got an e-mail out to him telling him where I am holding and if he has any suggestions
Otherwise I am at my wits end and have no rabbit to pull out of my proverbial hat!!!

Thanks for caring.  I am so greatful for OH.
Randy
Most Active
×