Here is the Anthem Medical Policy regarding revisions or change to different procedure after complications, hope this helps and hope that you will be approved.  It will be a fight I am sure but don't give up.

Repeat surgical procedures for revision or conversion to another surgical procedure (that is also considered medically necessary within this document) for inadequate weight loss, (i.e., unrelated to a surgical complication of a prior procedure) are considered medically necessary when all the following criteria are met:

• The individual continues to meet all the medical necessity criteria for bariatric surgery (see page 1); and
• There is documentation of compliance with the previously prescribed postoperative dietary and exercise program; and
• 2 years following the original surgery, weight loss is less than 50% of pre-operative excess body weight and weight remains at least 30% over ideal body weight (taken from standard tables for adult weight ranges based on height, body frame, gender and age, an example is available from the National Heart Lung and Blood Institute [NHLBI] at: http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm.

Thanks Nan! I friended you...and made my profile public...thanks so much!

Hi Nan!

   I am currently attempting to get approval for the sleeve. I am hoping to put a letter together as well! Could you please PM the letter you wrote so I could use it as a sample? Thanks so much in advance! I want to get this ball rolling!! :)

           Michele

Good Morning

i was wondering..for all of you who have have/had BCBC of MA..how long did it take for the insurance company to approve your surgery (Roux en Y)?  i am asking  because as of tomorrow i am done with all of my appoinments including medical clearance and I am so anxious

Julie

First of all, I'm new. I've been lurking since I found this site after my husband had VSG on 12/9. I was searching for unflavored protein, and found this wonderful group of people.

After some of the classes and seminars DH had to attend to get his surgery, I decided it might be a good thing for me as well. Trouble is, my PCP at Kaiser says my BMI is not high enough. I'm about a 37-38, have HBP and a scarey family history. Almost all the women on my mom's side of the family wiegh 300+, I'm always between 215-220. I have tried many diets and can usually get rid of 20 pounds, but no more, and it always comes back. Even after explaining this to PCP, he says I don't meet Kaiser's guidlines.

My DH's surgeon suggested I start by getting a sleep test (I snore) and if that comes back clear to write a letter stating my case to PCP and even higher up if needed.

So, now that you have some background, does anyone have any suggestions? I should hear back about the sleep study soon. If I have sleep apnea, I could potentially qualify. I am not in a huge hurry as DH's surgeon is in the reserves and is being deployed to Afghanastan and won't be back for a year. I figured it would take about that long to jump through all of Kaiser's hoops anyway.

Thanks,
Linda