Question:
Anyone on this site just resigned themselves to being fat and not had any surgery?
I am seeking a revision for a botched RNY from 5 years ago. The insurance company I had back then paid for it, but our new insurance company has a WLS exclusion. So unless a surgeon somehow says I have to have another surgery done, I doubt insurance is going to pay for it. We can't afford to self-pay. Anyone else in the same situation? Are there people on this site that HAVEN'T had any surgery done and are still wanting to lose weight? Are there people on this site who thought surgery was the way to go, only to have it not work out? I feel alone in this. Thank you for any comments. — [Deactivated Member] (posted on December 10, 2007)
December 10, 2007
Doctors and insurance companies are finding out every day that these
surgeries can go bad, and many did in the past. If you can find a surgeon
who can say that it is medically necessary for you to have a revision-I
would bet money that insurance would pay for it even if you had to appeal
them over and over. I am qa billing specialist who works for one of the
lragest Bariatric programs in TX. My surgery is being submitted for RNY
sometime in April. by choice I am waiting until Summer to take time off. I
have had to get 5 years of obesity history, a psych eval, 6 months of a
followed doctors diet and all this si just for medical documentation.Blue
Cross will pay for RNY but you have to have alot of other problems like
hypertension and diabetes, and sometimes other problems can help you get
approved. i worked all these companies and learned that everyone is
different.If your doc says that you last surgery was a failure and
problematic and causing issues for you know-they will do what is called a
predetermination. Once that is done the insurance company must give you
exact reasons why they won't approve and they will give you time to gather
the clinical you need to prove them wrong. With Lap-Banding out now they
are being very cautious becuase over time those bands cause trouble for
people, unlike RNY.You just have to prove your case and ecide what it is
worth to you.Best wishes.
— [Deactivated Member]
December 10, 2007
Yes, I have bc/bs atheim and they have an exclusion. i am stilling waiting.
I will not give up. I had UHC before and you can only appeal twice and I
was turned down both times. Some days I feel I should give up and other
days, I just want my life back.
— dawnspaints
December 12, 2007
When you started gaining weight again, did you by chance have the diabetes
return or the hypertension. If either of these or even sleep apnea is still
present, then your surgeon should deem you medically necessary for the
revision. Please check out duodenal switch.com or the DS forum here. Just
another weight loss surgery, but works far better; only problem, you may
need extra cash, which is my problem right now; I need four grand out of
pocket, but please at least look into it.
— KRWaters
December 13, 2007
I had a VGB done 10 years ago and was never very successful with it. This
summer I had RNY. Insurance wouldn't pay for it and I could not afford it
so I went to Mexico for the surgery. Everything went wonderfully. I am
almost 6 months post op and 80 lbs down. I only need to lose about 40
more. I was so unhappy before and life is so sweet now. Don't give up and
explore your options. Don't feel alone. You have plenty of people here
that will be here for you.
Neisha
— neisha =.
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