Frustration over Blis rules on no revision surgeries.

gloinva · June 1, 2011

Hi All,

Well as a very unhappy bander who had a sleeve surgery date (6/20) Passed nutritionist appt.. pysc evailuation, and was waiting to take the sleeve class tomorrow I received frustrating news today. First, I am self pay, I was self pay in 2008 when I had my band put in. Used the same Dr. here in VA who was to do my sleeve. The call I had today was to tell me that Blis, the co. for self pay catastrophic insurance ( part of my surgery fee now may not approve revision to the sleeve because of all the complications that can occur).

My stats are below but I have kept off most all of the 85 lbs. (all but 12-15) in the 3 years I have had my band. Despite all the problems this band has given me. So my BMI is lower than someone who will be a new VSG patient. I have no major health issues, no diabeties, no history of clots, no HBP, I really am healthier than when I had the band surgery. The revisions my DR. has done from band to sleeve have all been paid by health insurance. They have not done a self pay revision. His results are good from what I can tell and he is a Blis participating DR.

My question is have any of you had this issue? Scrapping up the $ again was no small feat but now to hear they may not approve it means I might have to sign away permission to pay any and all possible complication costs if he will still do the surgery. Or just have my band out and nothing further done, which scares me of further weight gain. Despite my constant gerd, esophageal spasms. and not being able to eat solid foods well, I need this restriction!

gloinva · June 1, 2011

PS Apparently Blis covers first time surgery but not revisions. I could understand if I hadn't been successful with the band but I did well with the weight loss. They site the chances of stricture as high with the sleeve, but that would be for any sleeve right not just revisions from banding? Does anyone have figures on complication rates?

anonynurse · June 2, 2011

I don't have any figures for you, but I do know (because I did it for a living before nursing school) that most insurance companies are adopting "one in a lifetime" clauses whether they paid for the original surgery or not, and that those clauses are bullet proof. I too am paying out of pocket for my band to sleeve revision.

gloinva · June 2, 2011

Well, Good news Blis Ok'ed me after all for the band revision surgery to sleeve today. So I won't have to sign all my rights away after all to have the surgery. Though I am still self pay the Blis coverage will still be in effect for this surgery. YAY!

After all I've been through with this band I was worried to have this hanging over my head and possibly change my surgery plans. Now to just take the class I missed due to this upset and I'm on for being sleeved June 20th!!!!!!!