BCBS TX Revision

[Brttnyj89 30]

Hi! Just wondering if anyone has any success with getting a revision with BCBS TX! I am hoping to have a revision in April. I have my first doctors appointment in March. My insurance does not require a waiting period. The only qualifications is BMI over 30, psych eval, and to prove that the band has failed. When I talked to the office, they need to prove that my band has slipped, eroded, or the port is no longer where it should be. I would love to hear from anyone who has had success with this insurance!

[AceBlaque 17]

Hello, I have BCBS(not Tx)...the coverage was for one bariatric procedure per lifetime and in order to get a revision approved, there had to be an issue from the primary procedure. Once my physician proved my primary procedure failed (proved through EGD tests, existing comorbidities, gallstones/gallbladder complications that would be removed during revision) my revision was approved very quickly without a wait period. In my insurance submission, all of the test results were included even my gym membership to show I was continuing to make efforts on improving my health.

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[Lyne13 0]

Hello, I have BCBS(not Tx)...the coverage was for one bariatric procedure per lifetime and in order to get a revision approved, there had to be an issue from the primary procedure. Once my physician proved my primary procedure failed (proved through EGD tests, existing comorbidities, gallstones/gallbladder complications that would be removed during revision) my revision was approved very quickly without a wait period. In my insurance submission, all of the test results were included even my gym membership to show I was continuing to make efforts on improving my health.

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Congrats on the fast approval! I'm going through something similar. Hoping for a quick decision [emoji4]

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[AceBlaque 17]

Thank you, I think your approval will come quickly for you! Keep us posted, can't wait to hear the good news!!

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[Brttnyj89 30]

I'm really hoping for a fast approval! I started my pre op diet Tuesday. So far I'm down 4 lbs! I had my EKG and EGD done yesterday. Everything went well. The doctor told me that there wasn't much of a pouch left. I'm not sure how to take that.

[AceBlaque 17]

When I decided to pursue the revision the surgeon who performed my initial gastric sleeve performed my EGD. When his staff submitted the package for insurance approval that was all submitted, that submission was denied. Instead of submitting an appeal I opted to immediately see a bariatric physician that I could possibly get approval with within the last quarter of the year. After talking with my new physician a second EGD was performed, an abdominal ultrasound was done to view my gallbladder, an ultrasound on my legs and arteries and a stress test to actually monitor how I performed and breathed while cycling. The stress tests showed I had the capacity of someone 30 years my elder and showed a sac full of gallstones that my initial surgeon didn't want to remove and never did tests to show there was an issue. When these were submitted the 2nd time to my insurance, I was approved immediately for a revision, from a gastric sleeve to a duodenal switch. Although my first surgeon didn't submit and real problems with my sleeve, my second surgeon saw that a portion of the stomach was left during my initial surgery that should have been removed. My initial surgeon would not admit that there was an issue in the submission to the insurance company which was a cause of the initial denial. I'm now approaching my 3month post-op revisional surgery. I felt defeated after speaking with my first surgeon...stay strong you still have options

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