I was sleeved December 8, 2011. I lost some weight but not enough to help with my Type 2 diabetes. I'm suffering from severe GERD and in the past few years I was diagnosed with PCOS. My insurance company has denied it because of compliance and complications. My original surgeon left and the other surgeon didn't want to deal with her patients. I was told to find a new surgeon in my area who would see me.... well at the time NO surgeons would even draw my labs. That's why there is a compliance issue. I still had to see a doctor but they knew nothing about bariatric surgery or anything. When I submitted my paperwork BCBSNC said I wasn't compliant and I don't have complications. This horrible GERD should be a complication. I finally found someone who would see me as well as revise me but I want to know what can I do to get approved. I'm only required to have a psychological evaluation, nutrition, cardiac, pulmonary and blood work. I need to know what else can I do to so they will understand that all of this was out of my control. Any advice is welcome. Thank you,
I, too am suffering from severe GERD. GERD is a complication. BCBSFed read the requirements for a 2nd surgery. I don't have to go through the wait process. It has been more than 2 yrs and my complication is the GERD. My provider told me to get the surgery codes from my doctor and she would look them all up for my peace of mind. I found a new doctor to do my revision. You should be able to make an appeal based on your medical records. They will show that the doctors were not willing to assist you. Get letters or email copies reflecting when the 1st Dr. left and copies of the refusal of services when you were attempting to get resolution. I was so happy when I found someone who could really help me.
I'm loking into a revision for the same reason you stated.may I ask who is your Dr. In San Antonio also if you have the medical codes.can you please share them. I have the same insurance. I worked in san antonio.I'm up the road in ho u stone know.
My insurance denied it at first too.i still needed to lose more weight.my Dr did a Peer to Peer with insurance company to make them understand is was because of the gerd. They approved it.I had surgery 2016 and have lost another 62 lbs.Need to find the right dr to fight for you.