BCBS denial-revision

Grahamco
on 12/19/20 9:14 am

I had RNY gastric bypass in 2004. I lost 100 pounds with the surgery but unfortunately I have gained most of it back. I am looking to do a Revision surgery with Blue Cross Blue Shield federal. I have been denied this due to me losing at least 50% of my excess weight with my initial procedure which was 16 years ago. My surgeon has already done A power to peer with insurance with no approval. Has a anyone tried to appeal this, help please

Veggiewoman
on 12/20/20 4:34 am
RNY on 01/01/14

I would say you need to present additional medical reasons why you must have the surgery.

Do you have high blood pressure or pre-diabetic high blood sugar ?

If the pre diabetic condition is bad enough to get prescribed Metformin there is a very compelling reason to revise . Same thing for high blood pressure - it must be supported with prescription.( s)

These are called co-morbities and insurance companies will approve surgery at under the traditional BMI if diabetes and/or HBP are present .

Grahamco
on 12/20/20 7:07 am

I do high blood pressure. Thanks for the response

White Dove
on 12/20/20 7:40 am

You have to research your policy and plan. Many plans only allow one weight loss surgery per lifetime, even if it was self pay or from another insurance company. That ends up making revision self pay.

Your surgery was considered successful. The truth about the surgery is that most people lose about 100 pounds and gain back 20 pounds in year 3. Half of us gain back 50 pounds by year 5. By year ten it is fairly common for most or all of the lost weight to have returned.

Long term, weight loss surgery only works if you use the surgery as an opportunity to completely change your eating and exercise habits. Revisions rarely result in more than a 20 pound loss. And that loss is from the pre-op diet and not being able to eat much for a while after surgery. The body recovers and even that weight comes back.

That magic 100 pounds of easy weight loss after surgery is a once in a lifetime deal. It does not happen with revision. You can lose weight by eating less and moving more. It sounds impossible, but start small and set a goal to lose five pounds at a time.

I had surgery in 2007. I have had several times of gaining and losing it again. I just accept the fact that most of my life I will be "on a diet". I use MyFitnessPal or Weigh****chers to track my food. I wear a fitness tracker, weigh daily on a smart scale, and am always aware of what I am eating and how much I am moving.

I check into this site daily for support and inspiration.

Real life begins where your comfort zone ends

H.A.L.A B.
on 12/23/20 9:36 am

White Dove said it as it is.

I had my RNY on 2008. My weight fluctuates based on what and how much I eat. Initially I was dumping on more than 5 gr of sugar, now 15-20 doesn't even make me slightly nauseous. But unless I eat something after the sugary items, I would get RH (reactive hypoglycemia). That indicate to me that my body is very good to take any sugar from my blood and convert to fat n my body.

Over last 12 years my body fluctuated between 135- 175. Usually the 170 is my "O crap" moment when I go back to eating properly and losing the extra weight. I feel best at 150-155, even close to 160 is not that bad.

Last year this time I wanted to gain 10-15 lbs. Well, during the pandemic I gained 40 lbs. So starting this week I am on a path to lose 25 lbs. I know it won't be easy. I know it would take time, probably up to 6 months to lose it all. And that's optimistic. But I know my joints hate the extra weight I put on, I don't feel good at that level.

You may need to try to save and pay out of pocket, or you may try to lose some weight on your own. IMO keto diet can really help with weight loss after RNY. Higher proteins, lower fat and calories, since we have our own fat to lose.

I need to avoid dairy, because I have a hard time to lose any weight if I eat dairy. Another things for me to avoid are most commercial "keto" desserts, because a lot of them can be full of fiber and sugar alcohols and not nly I gas when I eat that, but I also don't lose weight when I eat them. I typically don't allow myself keto desserts until after a month on a very strict keto diet. Only then I may consider to add some "special snacks", that I typically make myself. First week is often the worst for me. But after I get "fat adapted", I often no longer crave sweets.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

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