Having GERD. Will insurance cover revision if BMI IS 31?

[NewlySleeved12282020 1]

I have been having terrible reflux. The dentist says I have corrosion on my back teeth… I have an appointment with my bariatric doctor to discuss an endoscopy to take a look at things in there. I’m hoping a revision will fix it. I have Blue Cross Blue Shield. On their website it says BMI of 40 or 35 and higher with medical conditions. I’m at a 31. I’m worried that they won’t cover the revision. Does anyone else have BCBS and needed a revision due to reflux with my BMI? I just want relief!

[liveaboard15 1,293]

Typically this is not for weight loss... This is to help another issue (GERD) so i dont think BMI would matter in this case... But call your insurance company to verify

[kcuster83 1,504]

The best thing top do is call your insurance company and discuss it with them. Or, wait for your doctor apt and let them fight the battle for you.

Insurance companies are so finicky it is hard to say. Sometimes they deny just for a "code" being entered wrong. You dr. office will know how to enter it and make it clear it is not for WL reasons, etc.

Goodluck GERD SUCKS! I had it for years and my gastric bypass has completely resolved it. (I did NOT have sleeve, I went with bypass from the start because of already having such severe GERD before hand.

[Dee Steppe 0]

I had the same thing, acid reflux terribly, weight gain just all around miserable. I had had the roux-n-y 15 years ago. I had called to check into the revision surgery and the first thing they did was an upper barium test. Low and behold I have a 2 1/2 cm fistula attaching my pouch to my remnant stomach. At that point, it became a repair of a complication instead of a revision. My surgery is coming up and I am so excited.

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[MaryRN66 49]

Not to be sneaky or anything, but weight belts under large sweatshirts can work wonders in getting your BMI up to Insurance-approving levels. Just saying...

[Tomo 1,191]

Having gerd was enough for me to get the revision covered. When I first went in to speak to my current surgeon, I had a bmi of 28. He advised to get the revision ASAP. Unfortunately, I didn't. I was so scared to get the bypass. Also, I was content with my weight loss (bmi 60+ to 28, steady for many years) and thought I could control the gerd with PPIs. I couldn't. I suffered terribly for years after that. Looking at it in retrospect, I was silly. Best thing I ever did.

[kcuster83 1,504]

On 12/3/2022 at 6:53 PM, MaryRN66 said:

Not to be sneaky or anything, but weight belts under large sweatshirts can work wonders in getting your BMI up to Insurance-approving levels. Just saying...

I love this! Insurance companies will do anything to screw you over and not cover things. Sometimes you have to fight their battle to get what you want.

My grandmother got breast cancer for a second time and insurance refused to cover reconstructive surgery because it was "plastics". She already had a single mastectomy and used a breast prosthesis. After her second WIN against breast cancer needed a second mastectomy and insurance would only cover another breast prosthesis!!

Now imagine, what holds everything in place? There is LITERALLY NOTHING THERE to hold your "breast" in their natural position. They would just slide and twist all over your chest. She faught for MONTHS to get covered. She ended up winning, but no one should have to fight so hard for something that is necessary! We pay our insurance and they fight us every step of the way!

[BZee23 0]

Any updates?? In a similar situation. Rooting for you!

[NewlySleeved12282020 1]

The first thing my doctor said was that my BMI was at 31 and that insurance would not approve me. Then she brought up another procedure called Lynx. Some kind of magnetic bead thing that would keep the opening of your stomach closed unless things passed through. I don’t want it. I had the lapband and it’s was the worst and I feel like anything they put in your body that can be removed, it’s not going to help me.

My bariatric doctor thinks I have a small hiatal hernia. They took me into radiology and made me drink the dye, but everything looked normal. In a week they are going to look down my throat to see if there is in fact a hernia.

I have new insurance this year, but it’s still the same company. If I don’t have a hernia, I’m going to push for the revision or any other options. I can’t keep taking anti acids multiple times a day on top of Vitamins, medications, etc.

[Dee Steppe 0]

Unfortunately, my surgery has now become self pay. I have bcbs of Florida and they refuse to cover anything bariatric. Because my fistula is from the previous gastric bypass, they will not cover it. I have exhausted every option.

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[lennonforever 1]

On 12/3/2022 at 6:53 PM, MaryRN66 said:

Not to be sneaky or anything, but weight belts under large sweatshirts can work wonders in getting your BMI up to Insurance-approving levels. Just saying...

Where can I get one of these? I’m serious

[Sanchezrc2 3]

I have aetna and they covered my revision, i also had hiatal hernia. I am 6 days post opp from having the duodenal switch.

[SeattleLady 277]

I have aetna and they covered my revision, i also had hiatal hernia. I am 6 days post opp from having the duodenal switch.

How are you losing and feeling? Was it worth it? I hope you have a great day!

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[Tammi J 4]

I have had the same issues and will be going in for revision surgery on March 23. I have already had Roux en y surgery that is 11 years old and I have a BMI of 27, insurance is covering the procedure to make my pouch back to its original size as it has stretched to double the recommended size. Luckily I have not gained a lot of weight back but do have the GERD complications along with a hiatal hernia. The surgery will address the gerd but at this time my surgeon feels leaving the hernia alone is my best option.

Hopefully your insurance doesn't give you a hard time as GERD is awful.

[NewlySleeved12282020 1]

I had the EGD done and all they saw was redness and no hernia. They told me insurance probably wouldn’t cover me. They are sending me to a GI doctor. I feel like I’ll have to push the issue to get this done or find a different doctor..