Evil Ziggy

So update on the whole process: After speaking with the Doctor and her Medical assistants we decided to go ahead and submit the claim (they never had to deal with submitting paperwork for a revision; only brand new patients). According to my Ins. for revisions a claim only needs the documentation showing that the band malfunctioned and not because of the patient. So we went ahead and did that with out submitting all the goodies that is normally required like 8 week weight loss and 5 year history and psych eval and they DENIED IT! Which believe it or not is GOOD news because they came back and said they are not requiring the 5 year morbid obesity requirement because of the documentation for the emergency removal. Of course my doctor did have to go to bat for me. She had to have a peer-to-peer review to justify the medical necessity. Got the call from my doc yesterday stating all I need now to get my claim approved is 8 week commercially recognized weight lost program and pysch eval. I'm kinda stoked about it and in shock that I can forgo the 5 year proof. Just need to keep my fingers crossed and good vibes until I get the surgery. Side note: Determination and persistence pays off. This was really uncharted waters for my doctors office. Be proactive and call the ins company, get the medical coverage guidelines, basically do their job along side them. Something could go missed. In my case the girls at the office had the wrong medical coverage guideline. That made the difference in the type of surgery I was covered for. Do your homework and also follow up with the insurance company after a pre cert or claim is filed.

Hi all, I'm am currently starting the process with insurance from band to sleeve. I had great weight loss with the band, went from 310lbs to 137lbs, but the band slipped in 2014 and had to have emergency surgery to get it out. Since then I have gotten back up to 280. My patient coordinator is thinking I will not qualify as a revision since I had it taken out and would have to go through the whole process which includes a 5 year history showing I was morbidly obese. Obviously there is no way to show that. Can anyone relate to this situation or know how to proceed? Did insurance cover. Any light shed on the topic would be amazing!