Jump to content
×
Are you looking for the BariatricPal Store? Go now!

I'm In Tears :(



Recommended Posts

Usually insurance companies will make exceptions for revision patients. For example, my policy "requires" a 6 month supervised diet. But even though my band has been out for more than 6 months, the requirement was waived.

Have you actually filed and been denied, or are you just reacting to the verbiage in your policy?

I know a lot of people who have had revisions from one procedure to another. The BMI requirement is usually waived. I actually don't know of a single case where a revision has been denied because the BMI requirement is not met. That certainly doesn't mean there aren't a lot of them out there... just that I personally haven't seen one.

super upset here. I'm a revision patient. got my approval denied. going through appeal now. BMI is 39.8 and they're denying it based on a BMI below 40 and that it hasn't been 2 years since surgery. (15 months isn't enough I guess). super upset!

Share this post


Link to post
Share on other sites

What insurance do you have? (If you don't mind sharing, or you can PM if you don't want it public.)

I was under 40 BMI when my insurance was submitted. My first request was denied, but not because of BMI. My appeal was approved, but long story short I'd changed providers by then. Still under 40 when we submitted to the 2nd company, and I was approved first time around. My father was approved for his WLS revision with a BMI around 30! (He'd been through some serious misery with food intolerance and gastroparesis, and was ridiculously thin).

Can you share your insurance company's requirements? I can't promise that I'll be able to help, but I can try to give you some suggestions.

super upset here. I'm a revision patient. got my approval denied. going through appeal now. BMI is 39.8 and they're denying it based on a BMI below 40 and that it hasn't been 2 years since surgery. (15 months isn't enough I guess). super upset!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Alisa_S

      Gearing up for my consult 01/14! Starting to get a little nervous.
      · 0 replies
      1. This update has no replies.
    • Goyafigs

      I had VSG 11.20.24 with Miguel Burch, MD Cedars-Sinai and I am 1 month post-op. 
      · 0 replies
      1. This update has no replies.
    • DaisyChainOz

      🥳 Jan 1 2025 - Day 1 of Pre Op, surgery on the 16th! 😬😅
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Just been waiting until time for my consult with my bariatric surgeon. It's scheduled for Jan 9th. Turns out I won't actually be seeing him. Apparently it'll be with his P.A.             Not sure what to expect. I thought this is where the surgeon would discuss the best surgery option for me. For years I had my heart set on the sleeve, but I've read so many people have issues with reflux - even if they've never had it before - that they've had to be revised to the bypass. I already deal with GERD & take 40 mg of Omeprazole daily, so I started studying about bypass and honestly, it seems like it might be the better choice for me. How can we discuss surgery options if the surgeon is not there?
      What happened at your first consult? Trying to get an idea of what to expect, or maybe I should say, what NOT to expect.
      · 0 replies
      1. This update has no replies.
    • rinabobina

      I would like to know what questions you wish you had asked prior to your duodenal switch surgery?
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×