Hard to be approved for revision?

swtmelissa
on 12/19/17 10:18 am - West Allis, WI

I had my initial RNY almost 11 years ago, and up until this year I have been able to maintain a weight loss of 160 lbs. I recently had my second child and went through a really hard time with post partum depression along with some complications from my epidural. I am back up about 60lbs and struggling to get the weight off because of some of the medications I am on for the PPD. I am seriously considering a revision but do not know where to start or how hard it is to get approved. My original doctor is no longer practicing so I would need to find a new doctor. I will have BCBS of IL beginning the first of the year.

Does anyone have experience with this insurance or know where to start or how to know if you even qualify for a revision?

300 Highest Weight / 153 Current Weight / 135 Goal Weight 

hollykim
on 12/19/17 2:49 pm - Nashville, TN
Revision on 03/18/15 with
On December 19, 2017 at 6:18 PM Pacific Time, swtmelissa wrote:

I had my initial RNY almost 11 years ago, and up until this year I have been able to maintain a weight loss of 160 lbs. I recently had my second child and went through a really hard time with post partum depression along with some complications from my epidural. I am back up about 60lbs and struggling to get the weight off because of some of the medications I am on for the PPD. I am seriously considering a revision but do not know where to start or how hard it is to get approved. My original doctor is no longer practicing so I would need to find a new doctor. I will have BCBS of IL beginning the first of the year.

Does anyone have experience with this insurance or know where to start or how to know if you even qualify for a revision?

are you sure your employer has bought the rider covering weight loss surgery?

If your employe hasn't bought the rider for its employees,the surgery will be excluded on the policy.

if they have bought the rider,then you can call the number in the back of your card when you get it and asked what the requirements for revision ar3 and if they even cover revisions,some insurances companies do not.

 


          

 

dcopehp
on 12/20/17 7:40 pm - New York, NY

For most insurance policies, you must have regained enough that your bmi is over 40, or 35 with other problems like being diabetic,etc.

then you would need to see if your insurance policies covers revisions and/or conversions. Most rny patients end up converting to a DS or SIPS. Having a revision to the gastric bypass hasn't had the best results.

you would want to research the procedures and see if they would be a good fit for you. If you want to move forward, there are only about 12-15 surgeons who will do the revision to a DS and another 10 or so who will do the revision to a SIPS (sometimes also called a loop-DS or SADI)

Donna L.
on 12/28/17 11:38 am - Chicago, IL
Revision on 02/19/18

If you have BCBS IL PPO basically everyone takes it here in the Chicago area with few exceptions. If it's Medicaid, typically bariatric centers of excellence take it. You must view your evidence of coverage and see if your insurance covers it if it's private insurance. Start by calling insurance or searching the medical policies on their website. Even then, you need the evidence of coverage specific to your particular plan.

For instance, here is the medical policy for BCBS IL in general, but your individual policy will vary depending on services the purchasing agency may have opted into. I'd call and inquire.

I follow a ketogenic diet post-op. I also have a diagnosis of binge eating disorder. Feel free to ask me about either!

It is not that we have so little time but that we lose so much...the life we receive is not short but we make it so; we are not ill provided but use what we have wastefully. -- Seneca, On the Shortness of Life

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