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Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
So far its so worth it ❤️ -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
Surgery date is scheudled for the end of this month -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
Thank you! my Peer 2 Peer is Nov 2nd. So we will know more then ❤️ -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
wow yeah that is much shorter...I also had to ask my baratric team for a copy - as I still havent recieved one from BCBSNC. Well I sent over my "compliance" with diet and exercise from the first surgery...hopefully its enough info. I also sent in proof I was proscribed anti acids for months during my pregnancy and doctors notes on how intolerable it was to eat and take meds with my gerd... we will see if thats enough with the peer to peer review...I'll keep updating on here when I hear something. you give me hope...thank you for sharing! -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
BTW this is what BSBCNC said to me. They just seem like they auto deny and don't even check records as we have been so compliant and have plenty of evidence. It sucks because I don't even live in NC - I only have this because I work remoltely for a company in NC and live in CA.. We are gearing up for the peer 2 peer now but here is what was said: Revision of a primary bariatric surgery to a gastric bypass is covered when you meet one of the following scenarios: (1) You have regained weight after your original surgery. In this case, you must continue to meet basic criteria for weight loss surgery, including nutritional and psychological assessments, and you must have documentation of compliance visits (including compliance with nutrition and exercise recommendations) after your previous weight loss surgery (2) You have severe reflux disease that has not been responsive to optimal medical management (maximum medication therapy, diet alteration with the assistance with a nutritionist, and change in activity and positioning). Failure of medical management must be documented, and studies to support persistent untreatable reflux must be submitted. Review of your provided records reveals that you have regained weight after your previous surgery; however, we have not been provided with compliance records from your prior post-surgical visits. Additionally, it does not appear you have undergone optimal medical management for your reflux or that studies show severe signs of reflux. -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
That is really good to know. My particular situation is I had a baby eariler this year and gained 80lbs from pregnany. I"m 6months post partum and still breastfeeding so that makes me super nervous but docs say I should get the revision. -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
Thank you for the insight! I definitely need to slow my eating down too - what is foamies? I dont think I’ve experienced that with sleeve. -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
Wow that’s amazing progress! I’m so thankful you responded back to me! Sounds like you’re having a happy ending. Any advice on the revision? Anything you would change or prepare for? What would you tell yourself before the surgery? -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
Congrats!! I'm so happy for you! how has your journey been with revision? -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
hello there! Any updates? I"m in the same situation with BCBSNC...wondering what happened. I'm in the middle of proving to them that I followed instructions... -
Revision Denied by BCBS of North Carolina
Ambular replied to Liv_94's topic in Revision Weight Loss Surgery Forums (NEW!)
hello there! Any updates? I"m in the same situation with BCBSNC...wondering what happened. I'm in the middle of proving to them that I followed instructions...