Pennsylvania highmark bcbs revision

[Stacylynn1982 13]

I had my lap band surgery in 2010. Over the last two years I have had nothing but issue after issue with my band. Horrible reflux, stomach pain, vomiting etc. solid is now a nightmare. I would love to get this band out of me, but would definitely want a revision to gastric bypass. Has anyone had issues and/or success with highmark bcbs in PA? I see my new surgeon next week and just wanted to know what to kinda expect, thank you all so much!

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[Donna415 47]

I work for insurance and also have Highmark pa, it all depends on your benefits and if your employer chose to cover revisions. If they didn't choose yes or no either way, it would come down to medical necessity and medical policy. If you call your insurance, they will send you the medical policy just for reference.

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[Stacylynn1982 13]

Oh thank you!! I will call tomorrow and have them send it to me. Great info!

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[Donna415 47]

No problem speaking of...I may actually have it in my email from when I got it for my doctor. If I do, I can send it to you

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[Donna415 47]

I sent it to you but here is the part about revisions.

A conversion from an adjustable band to a sleeve gastrectomy, RYGB or BPD/DS for individuals who have been compliant with a prescribed nutrition and exercise program following the band procedure, and there are complications that cannot be corrected with band manipulation, adjustments or replacement.

Inadequate weight loss due to individual noncompliance with postoperative nutrition and exercise recommendations is considered not medically necessary for revision or conversion surgery and is non-covered.

Repeat procedures for repair, revision, or conversion to another surgical procedure following a gastric bypass or gastric restrictive procedure are considered not medically necessary when the criteria listed above are not met.

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