Insurance Revision Requirements

[AceBlaque 17]

Hello, I'm in the I'm in the process of getting insurance approval for a revision surgery. I was sleeved two years ago. Did any of you face any complications with your insurance regarding the revision? I've completed my EGD and psych evaluation and was told by my surgeon after tests that I am a great candidate for a revisional(Insurance still needed to approve though)... but honestly I'm afraid of being denied, it feels as if the first surgery was a huge blessing and I'm hoping and praying I get another! Any information you're willing to share about the revisional approval process is greatly appreciated as I will be submitting to insurance by the end of week. Thanks so much for tak injng the time to read and post or email me back!

[jenzds75 15]

I had the lapband 2009. I had to go thru the whole process with Cigna. I was approved & surgery is scheduled June 22

[SIPS in Seattle 344]

I'm currently waiting for approval for revision band (2011) to DS. My surgeon says he's bracing for a fight because my band technically is still functioning, no slips and I was denied twice for the band in the first place. I just completed my three months visits, all the tests etc so now it's the waiting game. Doc wanted to submit last Friday (two days ago) so I don't know yet if that's happened. Fingers crossed.

[jenzds75 15]

Same here- my band was still functioning. It's just I haven't been losing weight. They wanted to make sure I complied with the follow ups with the band. I was approved the first time.

[RickM 1,747]

While insurance companies will vary on their policies, in general, if your weight is still, or has regained to, the typical 35/40 BMI standards, then you are good to go (assuming that there are no lifetime limitations for WLS that apply.) If the revision is due to complications of the original surgery, then the BMI restrictions usually don't apply.

[AceBlaque 17]

Congratulations!!! Please let me know how your surgery goes.

[AceBlaque 17]

I'm currently waiting for approval for revision band (2011) to DS. My surgeon says he's bracing for a fight because my band technically is still functioning, no slips and I was denied twice for the band in the first place. I just completed my three months visits, all the tests etc so now it's the waiting game. Doc wanted to submit last Friday (two days ago) so I don't know yet if that's happened. Fingers crossed.



I'm sure you are going to be successful because a friend of mine still had a functioning band and had been denied before but bc the years had passed and proven that the band would eventually be better if replaced to avoid complications in the future. I'm excited for you!!!

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[AceBlaque 17]

While insurance companies will vary on their policies, in general, if your weight is still, or has regained to, the typical 35/40 BMI standards, then you are good to go (assuming that there are no lifetime limitations for WLS that apply.) If the revision is due to complications of the original surgery, then the BMI restrictions usually don't apply.

Thank you Rick!

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[SIPS in Seattle 344]

Thanks@AceBlaque

Fingers crossed for everyone 🤞🏼🤞🏼🤞🏼🤞🏼🤞🏼

[Lynzee43 28]

Unfortunately it's a toss up! I had lapband 11/2009 and had it out 9/2012 due to slip and god awful heart burn and reflux issues - insurance wanted me to start ALL over again as a new patient, my Dr had to justify why I shouldn't have to start all over. Thankfully insurance company got their head outta ass and I had sleeve done 10/2012.....best thing I ever did and wish it had been option when I had band done(I'd of skipped band)!

[SIPS in Seattle 344]

I just got my approval call yesterday. Originally my doc said they were going to go for approval on 6/9 but I got an email on 6/13 saying that they were submitting that day. Got the call yesterday 6/16. I'm still in shock!

[AceBlaque 17]

I just got my approval call yesterday. Originally my doc said they were going to go for approval on 6/9 but I got an email on 6/13 saying that they were submitting that day. Got the call yesterday 6/16. I'm still in shock!



Why am I over here excited like its me!! I'm so happy that you got your call!!! Please post as you near your date!

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[AceBlaque 17]

Same here- my band was still functioning. It's just I haven't been losing weight. They wanted to make sure I complied with the follow ups with the band. I was approved the first time. [emoji4]

Thank you, these words give me encouragement.

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[AceBlaque 17]

Unfortunately it's a toss up! I had lapband 11/2009 and had it out 9/2012 due to slip and god awful heart burn and reflux issues - insurance wanted me to start ALL over again as a new patient, my Dr had to justify why I shouldn't have to start all over. Thankfully insurance company got their head outta ass and I had sleeve done 10/2012.....best thing I ever did and wish it had been option when I had band done(I'd of skipped band)!

I'm glad you mentioned about the process of starting over, I will ask my doctor if he can include that in the submission as well since my submission to insurance was postponed until they get the records from my pcp this week. Thanks so much!

[SIPS in Seattle 344]

My date is 8/8 they wanted to do 7/18 but I'll be in the process of moving at the end of the month so I thought it would be better to wait til august.

I'm sorry did you mention who your insurance is? I tried to look back but I might have missed it. I too thought it would be a battle but I got approval the first time around. I thought it would be a battle because my band took two appeals. I'm below 40 (both times) without significant comorbidities... but it went through so fast I am still in shock.

I'm hoping yours does too!