Insurance & Revision. Hope someone can help!

[BrooklynMomma 11]

Hi Everyone,
I had a vsg back in 2016, I’ve had regain and want to have a revision. Of course insurance won’t cover unless I have gerd or other issues. I did my surgery with GHI/Emblem Health. If I switched insurance to Aetna or another insurance would I get approved because I didn’t do the 1st surgery with them? I’m hoping someone can help me with this question 😞

[smg 471]

How much regain have you had? Is the regain from not following a long-term exercise and diet plan or are there other health issues that prevent you from following these plans? You're correct, they're most likely not going to cover a revision if there are no underlying health issues aside from regain.

[MeliE82 5]

There has to be an issue as to why it would warrant a revision , as my insurance coordinator explained to me they won’t approve it unless there is a medical reason for it , I had tried to get a revision from lapband to sleeve last year but I didn’t have enough documentation for medical necessity so i got declined . This year a lot happened and I was diagnosed with sleep Apnea , GERD, Esophagitis so it made me eligible , but because of my GERD and Esophagitis I will be getting RNY instead due to reflux issues with Sleeve . As far as switching insurance companies just because you didn’t get something with one company would it void the ability to get a revision with a different company , it’s all about the companies Bariatric guidelines and how they measure medical necessity .

[New&Improved 1,780]

2 hours ago, BrooklynMomma said:

Hi Everyone,
I had a vsg back in 2016, I’ve had regain and want to have a revision. Of course insurance won’t cover unless I have gerd or other issues. I did my surgery with GHI/Emblem Health. If I switched insurance to Aetna or another insurance would I get approved because I didn’t do the 1st surgery with them? I’m hoping someone can help me with this question 😞

As above it needs to be medically necessary... not just oh I didn't lose weight maybe another surgery will magically make me lose weight?