Revision... Aetna

[SIPS in Seattle 345]

Anyone been through a revision with Aetna?

I currently have the band, I initially went from 239 to 165 back up to 239 +/- in the past 5 years. I just started looking into revision surgery and would love to hear your experiences.

Thanks in advance

[O-Town Body Rock 148]

I am currently waiting to hear from Aetna for a sleeve to rny. My doctor's office just submitted today or atleast she said she was. Apparently the insurance coordinator moves at her own pace.

[O-Town Body Rock 148]

I have Aetna POS II.

[Ndonato 1]

I have the same the only thing they said is I cannot gain an ounce

[O-Town Body Rock 148]

Hi@Ndonato! Are they making you meet the requirements as if this is your first surgery? Because the Insurance coordinator at my surgeons office tried to tell me I had to start all over and she was very wrong!!! Aetna revision surgery requirements are different then the requirements to get the first bariatric surgery. If have GERD and a "deformed fundus" and a hernia. But in order to get a revision with Aetna, your first surgery had to have be "medically necessary". I got my sleeve done in Mexico in 2014 because back then, I went through the requirements process and was denied by Cigna Medical. So now my fight with my current surgeons office is "medically necessary" to WHO?!...the insurance company or the doctor?!?

[BREWSTER1 1]

What is the post op from band to sleeve, how long and diet?

[SIPS in Seattle 345]

Yes this is my question too, are they making you start as if this is your first surgery? Do you have to redo the supervised diet etc.

I too have POS II

[AnneElliot 79]

Woah! Before you take this irreversible step! Remember that as a revision you far more prone to complications!

Is it worth the weight loss? He'll no.

Get the band out and hold onto your stomach.

Many band to sleeve revision suffer with severe acid reflux a few years out. Some even need a revision to gastric bypass!

[O-Town Body Rock 148]

Here is a link to Aetna's policy on weightloss surgery.

http://www.aetna.com/cpb/medical/data/100_199/0157.html

[SIPS in Seattle 345]

2 hours ago, O-Town Body Rock said:

Here is a link to Aetna's policy on weightloss surgery.

http://www.aetna.com/cpb/medical/data/100_199/0157.html

Thanks! I read the policy. I'm just worried how this will play out. Originally I had to fight for approval, took two appeals with the assistance of obesitylaw.com So.. I fear, will they say it wasn't medically necessary? And, did you have to redo the original requirements? Supervised diet etc?

2 hours ago, O-Town Body Rock said:

[O-Town Body Rock 148]

For revision surgery, i met their complication requirement so this isn't looked at as needing to do the original requirements. I currently have the sleeve and if i had to meet their original requirements my BMI isn't high enough nor do i have a comorbidity. So even if i dont get approved for rny, i still have to get the hernia removed and the extra, deformed part of my stomach removed. I hope that makes sense.

[Ndonato 1]

I have gerd and a hernia but I did not have surgery already this would be my first. I have seen that anything insurance doesn't cover has to do with your company. My company refused to pay for any Bariatric drugs but will pay for surgery

[SIPS in Seattle 345]

Thank you both for you input, I appreciate it!@ndonato and @O-town body rock

[O-Town Body Rock 148]

1 minute ago, Here I go Again... said:

Thank you both for you input, I appreciate it!@ndonato and @O-town body rock

No problem at all! Please keep me posted. I am sitting here with my cell phone in my hand waiting to receive my verdict from the surgeon's office now...

[SIPS in Seattle 345]

No problem at all! Please keep me posted. I am sitting here with my cell phone in my hand waiting to receive my verdict from the surgeon's office now...

Fingers crossed 🤞🏼