SLEEVE TO BYPASS REVISION

[chasingpolaris321 214]

Insurance question!!!

I'm really confused at the moment because I was just told by my surgeon's office that a 6 month nutrition plan is required by my insurance company "to see if I can lose weight on my own before surgery."

I'm having the surgery because of severe GERD and I have lost 100 pounds in this past year since I had my sleeve and have been completely program compliant. I am at a normal BMI.

This sounds like a mistake, right? Did anyone experience something similar?

[SleeveandRNYchica 1,155]

I don't know if the insurance coordinators are presenting the facts as revision due to other medical issues....

[Titaniumsleeved2014 42]

Sounds like you need to verify that they filed the claim as a revision due to GERD.

[chasingpolaris321 214]

I heard back from them and the 6 month thing was a mistake, but she still gave me kind of a confusing list of requirements. I think she lumped the "revision due to weight regain" in with the "revision due to complications."

One of them though, was evidence that I had adhered to nutritional guidelines. Isn't that just being a normal BMI? I don't have recent documentation of meeting with a nutritionist so I hope it's okay. They make everything so complicated!

[Titaniumsleeved2014 42]

What insurance do you have because I'm in the process of trying to have the revision due to GERDS as well

[chasingpolaris321 214]

I have Cigna Open Access Plus. It covers bariatric surgery and revision, I'm just worried there will be some weird requirement that I haven't thought of. I live outside of the US right now and I have a limited window when I'm going to be home to have the revision.

What's your insurance? Have you started the process yet?

[SleeveandRNYchica 1,155]

Yeah I am dealing with a coordinator but she is challenging doesn't return calls or emails. I am done with my requirements I go to see my PCP tomorrow and will be sure everything is documented for me so it's more that just lack of weigh loss even though that is an issue too. I don't think the coordinators understand the revision process in total.

[Titaniumsleeved2014 42]

I have United healthcare no requirements weird as of yet just the usual test EDG and Barium swallow so far

[chasingpolaris321 214]

I'm hoping that will be the case for me. I have to fly back in September to do testing and meet with the surgeon so I won't know more until then. I am crossing my fingers that things go smoothly! I don't think the coordinators are used to this type of revision and so it is frustrating to try to get ahold of them through email and Skype and get nonsensical answers. Good luck to everyone!

[Titaniumsleeved2014 42]

Best of luck

[MichJohn77 39]

Just got my call that I was approved for my revision from sleeve to bypass! Was submitted to BC/BS PA only 2 days ago! I was approved because I have stenosis with SEVERE GERD! Surgery date 8/31!

[superslim 13]

Got banded 4 years ago achieved goal weight quickly was very happy until it slipped, I changed to a sleeve revision one year ago regained all my weight, No restriction with sleeve, now I'm getting a mini bypass in October, any views would be appreciated. I live in the U.K. So our health service doesn't cover wls so all surgeries have been privately funded.

Edited August 19, 2015 by superslim

[chasingpolaris321 214]

Just got my call that I was approved for my revision from sleeve to bypass! Was submitted to BC/BS PA only 2 days ago! I was approved because I have stenosis with SEVERE GERD! Surgery date 8/31!

Did you have to fulfill any requirements? I have had a hard time getting an answer from my clinic on what my insurance is going to require. I am at a normal BMI and am revising due to severe GERD/Barrett's.

[MichJohn77 39]

Did you have to fulfill any requirements? I have had a hard time getting an answer from my clinic on what my insurance is going to require. I am at a normal BMI and am revising due to severe GERD/Barrett's.

Yes I had to do the upper GI. 1phych visit, 1 nutrition, I already had a bunch of testing from my Gastro doctor like a gastric emptying scan and EGD and his office notes.

[chasingpolaris321 214]

Did you have to fulfill any requirements? I have had a hard time getting an answer from my clinic on what my insurance is going to require. I am at a normal BMI and am revising due to severe GERD/Barrett's.

Yes I had to do the upper GI. 1phych visit, 1 nutrition, I already had a bunch of testing from my Gastro doctor like a gastric emptying scan and EGD and his office notes.

Okay that all seems manageable. I just know from the sleeve how crazy insurance requirements can be and I just am hoping this is simple since I stuck with my program and lost the weight and there's nothing I can do about the GERD. I only have one EGD that was done out of country so I'm guess I'll probably have to do some more tests. Good luck on your surgery! I'd love to hear your experience.