losing_the_band 133 Posted August 3, 2011 I spoke with the insurance coordinator for my new surgeon's office today. She says that even though he says that a revision to the sleeve is medically necessary, my insurance will probably not pay for it. Apparently, my insurance makes patients meet all the same restrictions that they had to meet for the first surgery, including having a high BMI for two years before the revision, regardless of whether the revision is because of complications from the original surgery (severe pouch dilation in my case). I'm ready to scream. My insurance is excellent except for this one clause. Share this post Link to post Share on other sites
mcast 0 Posted August 5, 2011 I spoke with the insurance coordinator for my new surgeon's office today. She says that even though he says that a revision to the sleeve is medically necessary, my insurance will probably not pay for it. Apparently, my insurance makes patients meet all the same restrictions that they had to meet for the first surgery, including having a high BMI for two years before the revision, regardless of whether the revision is because of complications from the original surgery (severe pouch dilation in my case). I'm ready to scream. My insurance is excellent except for this one clause. What insurance do you have? Mine had the same clause...Aetna. It's a ridiculous requirement for revisions!! I was denied initally for the same reason. My doctor did a peer to peer...denied again but then I wrote an appeal letter and won....quickly too. I can send you a copy of it if you'd like. Share this post Link to post Share on other sites
losing_the_band 133 Posted August 6, 2011 What insurance do you have? Mine had the same clause...Aetna. It's a ridiculous requirement for revisions!! I was denied initally for the same reason. My doctor did a peer to peer...denied again but then I wrote an appeal letter and won....quickly too. I can send you a copy of it if you'd like. I have Federal Blue Cross Blue Shield, and my policy doesn't state any exceptions for revisions due to band failure. The likelihood that my insurance company will change their minds about a denial is extremely slim. There's a member here or at OH that had the same company and was in a similar situation as me (located in the same state and even had the same surgeon), and she couldn't get them to change their denial at all and eventually gave up and had to go to Mexico to get her band. I think that what I've decided to do is to focus my energy right now on getting approval for getting my band repositioned and then saving up to possibly self pay in the future. I would like to give my band one more chance, since it worked very well for me until I became too tight and caused a lot of problems for myself. I work for the federal government, so if I have to, I do have the option of changing insurance companies in the future if my band fails again. The other insurance company would be SAMBA/Cigna, and it has a seemingly more lenient policy on revisions due to complications, but I've heard stories of what a nightmare they can be to get approved, too. Share this post Link to post Share on other sites
Ricky 6 Posted August 7, 2011 I have Fed BCBS too...I gave up fighting and went to Mexico. Best wishes to you and your success!!! Share this post Link to post Share on other sites
HunnyBunny 5 Posted September 7, 2011 What insurance do you have? Mine had the same clause...Aetna. It's a ridiculous requirement for revisions!! I was denied initally for the same reason. My doctor did a peer to peer...denied again but then I wrote an appeal letter and won....quickly too. I can send you a copy of it if you'd like. would you send that to mr please. Share this post Link to post Share on other sites
