Question:
Anyone have insurance problems related to approval of a revision?

I had my original WLS in 1998 and am in need of a revision. I lost 125 pounds, but have gained 70 of it back. My doctor has agreed to this revision; however, BCBS has denied my first request. My BMI is 35.5, apparently not high enough. I do not want to have to gain more weight to truly be morbidly obese. I feel that my co-morbid conditions and prior history being morbidly obese should indicate the need for this new WLS. If anyone else has walked down this path, I would truly appreciate hearing from you. Thanks    — Cindy H. (posted on March 5, 2003)

March 5, 2003

   — ellton

March 5, 2003
The issue with BCBS might actually be that your surgeon wants to do more than a 100cm bypass in the revision. BCBS does not like what they call long limb RNY's, which in their book is longer than 100cm. The 35.5 BMI without significant co-morbs is the other major issue. Good Luck!
   — zoedogcbr

March 5, 2003
I only regained 12#, but had successfully kept off 100# before my staple line disrupted. The only expense to my ins company is routein labs & such to keep me healthy,. NOTHING like when I was full sized. My doc wrote a beuatiful letter listing my comorbs (think $$$$ for weekly visits) and assuring them that regain WOULD happen, not "might". The ins looked at it as a "repair" to a working surgery & poof, it was done. I thought it was a miracle. I've seen many get approval to change surgery types based on insufficient wt loss (or regain), but of course, they all had different insurance types.
   — vitalady

Click Here to Return