My revision denied due to an exclusion... any experience with this?

I still haven't submitted the appeal. I have been having health issues... and I think I have esophogitis. I go to the doctor soon. I can't swallow food and I have bad chest pains. May be esophagus episodes. I will keep you updated.

Do you mind if I ask a couple of questions about the Nicholson Clinic? Is the $18K for the bypass? Do you know what all that entails, ie hospital costs, anesthesia, surgeon fees? does that also include the band removal? After two years of fighting with my insurance company they have finally agreed to pay to remove my band but not another wls procedure. They are saying that I have not had a BMI of over 40 for the past five years; no kidding, I had a lapband...... So tired of the insurance merry go round and am looking to self pay for the bypass. Thanks for any information you can provide.

hi im interested in revision also.I had surgery in 2002 and im back up there again.My insurance wouldnt cover but now I soon will have blue cross blue shield Im crossing my fingers.

Thanks for the feedback guys. My benefits package states that bariatric surgery is not approved "for the purposes of weight loss". However, I do have GERD, and it worsened after the sleeve. In addition, there is something wrong with my esophagus, and I have a hiatial hernia. I know with gastric bypass, it can alleviate these symptoms. Often people get revisions for GERD. Maybe this is a loophole, maybe not. But I haven't submitted it. There has been a death in the family, issues in my personal life, and health issues. But I promise I will keep you posted. Maybe my journey can help someone else. Even if it is a denial, there is no harm in trying. Keep me in your prayers.

Thanks,

Kay

Sorry to read about your loss, sending blessings for the best that the universe can send you and yours! When you write your appeal, make sure that you use chronological orderm so you can clearly reflect the comorbidities you are currently experiencing. I believe you will receive your revision! Just don't give up!

Can you explain further? Like you mean to use dates as the symptoms existed?

Everyone has a different policy but my experience is the opposite. I had the sleeve a little over 2 years ago and now need a revision due to severe GERD. I have received two different denials from the insurance company because bypass is covered for weight loss but not GERD. The insurance company told me this morning complications from sleeve are not addressed in my policy. I suppose they would rather pay for the chemo if I get cancer and the expensive PPI and Carafate ($over 700 a month they are paying) I'm on which do not work to control my reflux. I hate insurance companies.

Hello All,

Thanks for your comments and support. I decided to just talk to the CEO about the exclusion. He was VERY understanding! He asked for documentation that the revision surgery will help alleviate the GERD, can fix the hiatal hernia, and will help with the esophageal spasms that I am having. He will then consult with his insurance broker and come to a resolution. He seems pretty supportive.

That is wonderful that he willing to go that extra mile to help.

Yes that is awesome! I prayed before I went to him. Honestly, I was prepared to defend my position of the surgery and prepared for him to be defensive. However, when I did approach him, not only was he eager to listen, but he knew of the complications GERD can bring and he was telling me how I need to get it fixed! I did not have to prove or debate anything. I am grateful for his compassionate heart. Hopefully, there will be a resolution for me. And if not, then at least I know that I did all that I could to get a revision.