Search the Community

Hi all, I had the RNY (revised from gastric band) 7 years ago and had amazing success. I got to my goal weight in 5 months and kept the weight off for over 5 years. In the last 18 months, I've had some medical issues that have resulted in me regaining almost all of the weight. Now that I have resolved those issues, I am maintaining my weight, but finding it impossible to lose again like I did before. There has definitely been some stretching of my pouch, which my surgeon has confirmed. So I guess my question is, has anyone out there had the Edoscopic Sleeve Gastroplasty done? I have an appointment with my surgeon next week to discuss non-surgical options and I think this will be one of them. All of the research I've done shows it's a great option for regain after bariatric surgery but I'd love to hear from someone who has had it done. If you have had it, how did you recover? Did you lose as much weight as you did with your initial surgery? Did you keep it off? What was the post op diet like? Any and all feedback and comments welcome! P.S: I'm in Melbourne, Australia

RHW94123....what is the name of that additional insurance that will cover the revision? I need a revision from band to RNY and of course my state Ohio is not on the list of covering weight loss surgery and my employer has an exclusion.

Garvey, to answer your question about getting complications from bariatric surgery covered in 2014. My husband and I own a small business and we buy individual health insurance policies for ourselves. To be compliant with Obamacare, our individual policy can no longer fail to cover pre-existing conditions starting next month (Jan 14). Before getting sleeved last month, I wanted to research the Obama-compliant policy I would be getting January 2014 and make sure that it couldn't/wouldn't disallow taking care of me if my ailment was a result of voluntary/elective/bariatric/cosmetic surgery. I persisted until I found the fine print and what my 2014 policies reads is something like "bariatric weight loss surgery of any kind is not covered, but revisions to and care of complications from such surgeries are covered to the extent necessary to remove the patient from peril." (or something jargon-y and long like that). I knew that 2014 policies couldn't "not" take care of you because of a pre-existing condition and--though jargon-y-- I was satisfied by the language that I read that they would now bail you out if you had a problem after self-pay bariatric surgery. SORRY SO LONG -- I was trying to be detailed and I probably just confused you more, lol ! (An analagous situation that I read in my new policy was that if you had breast implants that ruptured, they would not help you out for cosmetic reasons... but if the rupture was causing an ailment they would care for you/remove/revise just enough to get you out of peril [which I took to mean they would take the old ones out surgically, but not cover to add new ones in the vacant spot ].)

Call BCBS & find out their requirements. You should have done that first. Know your benefits, what will you have to pay, & what they expect out of you. I have BCBS North Carolina & they don't require anything if you have BMI over 39. I just submitted it (I do authorizations for a living) & gave BCBS my height, weight, & BMI. I got an approval in 3 days. Each BCBS has different requirements. I am assuming CAL is California? BCBS California is BCBS Anthem. -----------------------------------------------\\\ ANTHEM BCBS – REQUIREMENTS FOR WEIGHT LOSS SURGERY In Am I Covered by OC StaffOctober 19, 2013 Anthem BCBS does cover weight loss surgery as long as your policy does not specifically exclude coverage. ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. So we are happy to report that Anthem BCBS covers weight loss surgery. In fact, most of the Blue cross Blue Shield network has some sort of coverage for weight loss surgery. It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. Opting-out typically saves the company money on their premiums. Contact information for your Anthem BCBS is listed below. Even if your policy excludes weight loss surgery, because BCBS has shown that these types of surgeries are medically necessary you might be able to appeal their exclusion. Before calling make sure you see our questions to ask before calling your insurance company section. Note Blue Cross of California is the trade name for Anthem BCBS so your criteria for weight loss surgery will be the same as it is here. ANTHEM BCBS PRE-APPROVAL REQUIREMENTS The items below are the minimum necessary for approval of your weight loss surgery. Body Mass Index (BMI) of 40 or greater OR… a BMI of 35 or greater with at least 2 comorbidities. Primary Care Physician’s Letter. Active Participation and Documentation of non-surgical methods of weight loss. 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). Consult and recommendation from a weight loss surgeon. Psychological evaluation Nutritional evaluation Policies Included in Coverage Blue cross Kentucky Blue cross Virginia Blue cross Wisconsin Blue cross Ohio Blue cross California Blue cross Georgia Blue cross Missouri Blue cross New York Empire TYPES OF WEIGHT LOSS SURGERIES COVERED BY ANTHEM BCBSRecently gastric sleeves have begun to be covered by some of the large insurance companies as a primary weight loss surgery. Currently, gastric sleeves are considered experimental procedures and are not covered. Covered Weight Loss Surgery Procedures Laparoscopic Gastric Bypass Open Gastric Bypass Surgery Gastric Banding – including the Lap Band and Realize Band Duodenal Switch also known as Biliopancreatic Diversion Gastric Sleeves Unsure which surgery is right for you? Take our bariatric surgery test! Lap Band Fills Covered? Anthem BCBS considers Lap Band fills a medical necessity when required to meet the proper level of weight loss. This is true only if you’ve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance. Procedures Excluded From Coverage Mini-gastric bypass Banded vertical gastroplasty Any other ‘experimental’ weight loss procedure Is a Second Weight Loss Surgery Covered if Gastric Banding Didn’t Work? Surgical procedures following a previous weight loss surgery that did not result adequate weight loss, such as a lap band or realize band to a gastric bypass, gastric sleeve or duodenal switch are covered by insurance when the following criteria are met: The patient continues to meet all the medical necessity criteria for bariatric surgery, and There must be documentation that the patient was compliant with the original post-operative dietary and exercise program, and 2 years after the original weight loss surgery, weight loss is still less than 50% of pre-operative excess body weight and weight remains at least 30% of the patients ideal body weight, per BMI. Revisions Revisions are covered if there is documentation of a failure secondary to a surgical complication. Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line.Does Anthem BCBS Require Center Of Excellence? Yes, weight loss surgery must be done at a Center of Excellence. Do I have to use an in-network weight loss surgeon? No. However, your deductible and out of pocket costs may be significantly lower if you do. And you will still need to find a surgeon that has privileges to perform the surgery at a accredited Center Of Excellence for Bariatric Surgery. ANTHEM BCBS CONTACT INFORMATIONAnthems can be contacted at 1-866-293-2892. You can also locate a contact number and email address on their website after choosing your state. ANTHEM BCBS WEIGHT LOSS SURGERY FULL COVERAGE STATEMENTAnthem’s full policy on weight loss surgery insurance coverage from their web site.

I knew it was time when I put on 30lbs in a year w/out trying!! I had a lot of life changing events all happen in the same time and before I knew it, I was back up to 206! At that point I decided to look at our health insurance options at work and switched to a plan that covered bariatric surgery (thinking I was going to get the Lap Band). I read the requirements over and over and qualified for all of them except for the BMI over 40. So, in Oct-Nov of last year, I ate and drank lots of Beer to gain the 25lbs needed to qualify. I know it sounds rediculous but I wanted this surgery! In January, at my first appt the insurance co told me that the 3month diet I had been on was too old and had to go through the surgeon's office. At this time I spoke to the nutritionist and she recommended this site. And directed me to the forum about Band to Sleeve revisions!! After reading all of the posts and speaking to others on here and at work, I changed my mind and went with the sleeve. The best decision I've ever made!! I'm considered a newbie at only 8wks post-op, but let me tell you, I've already lost 35lbs (all post-op) and I feel amazing!! Those 25lbs I gained to qualify took a huge toll on my body and energy and now that I've lost that, I feel great! I'm not hitting snooze on my alarm anymore and I'm staying up later too. I'm able to run up and down the stairs chasing after my kids, and am coaching softball again. I have a long way to go, but just these 35lbs have made a huge difference for me!! You will know when it's time! When you wake up one morning and struggle to get out of bed, or put your shoes on, or run out of breath walking a short distance... it's time!

I'm a sleeve to bypass revision...sleeved 12/13/12 and rny 8/16/13...mine was for extreme GERD/reflux reasons...I'm past my goal weight of 145 at 133 currently...I was told by my dr that I needed to wait 6 months before he would do the revision, and I was his first sleeve to bypass.

Good evening everyone just wanted to introduce myself. My name is Doreen I'm 57 and was banded May 4th of 2011. I was 239 when I was approved for the band and 229 the day I was banded. I now weigh 206 . I was 197 at my lightest but my band was giving me trouble so they took out 1/2 cc and I gained 8 lbs back and can't shake it. Saw my surgeon and talked to her about a revision. She agreed and wanted to do the sleeve but the results could be about the same as the band 30 to 60% of weight loss, not from where i am now but from where i started at 239 so I told her I wanted the bypass and she was fine with that. I got my blood work and upper GI in one visit then the nutritious and physic in one visit. All in one week then they put the paperwork in to my insurance co and I was approved in 3 weeks. She called me yesterday 9/11 and wanted to schedule it for the 16th (in 2 weeks). Unfortunately I have so much going on this month and next I had to schedule it for November 4th. I wish I could have it in 2 weeks. I'm excited and nervous all together.

Hi guys! I'm 24, I'll be 25 in April. In the process of planning my second wls: revision from the lapband to the bypass. The band just doesn't work for some people unfortunately. I'm hoping for a second at life!

From what I read Kaiser doesn't cover revisions. BUT I also know that every Kaiser is different and every situation is different. It sounds like you had an entirely different procedure . I don't know if I would even mention WLS to the doctor but I guess you kind of have to to figure out what really happened. I'm so sorry you're going thru all this. I am with Kaiser OC & I see a doctor in Santa Ana. Only seen her once and I'm pre-op right now, so I don't have much advice. Let me know if you want her info. Sent from my iPhone using the BariatricPal App

My dr told me that if the insurance approved it in the first place, they should cover anything pertaiing to it. I had to have a revision and they paid for it.

I'm a band to RNY and I trully loved my band, never had a problem just got po'd at the clinic I was using so switched doctors and just in the nick of time. I was going to follow up with band with the new doctor but he decided he needed to fluoroscope it and see where we were at with it since the other clinic never had in the three years I had the band. Discovered it had slipped and he thought it might be erroded. It hadn't erroded yet, but it had to come out on an emergent basis. So when the doctor and I discussed where to go from there he gave me the options of sleeve or RNY. I turned the table back to him and asked which he would recommend for me. He basically said since I was a type II diabetic that RNY would be the best as it shows over 90% remission for RNY patients. Sleeve doesn't give that good of results as you can still eat sugars and fats. The sleeve also has a faster weightloss than RNY but RNY is just a slower weight loss over a longer period of time. Also I am not too fond of having 2/3's of my stomach put into a hazardous waste bag whereas RNY if it needs to be revised it can be. I also based my decision on which had the most research available and of course RNY does because it has been around the longest and since the band is the next oldest and it is nowing showing a high failure rate I was afraid of the sleeve as it is the newest and not enough research coming in yet.

Oh my Goodness I think I have to revise my goal for this challenge: I currently weigh 209.8 so my new goal for New Year's Day 2013 is to be well on my way into the 100's................................196 pounds!! Woohoo!!

What they are saying is that the FDA has not PROVEN that there is a need for port revision when it is detached for the actual lapband surgery to work correctly. So they approved the lapband and I had it.. but when I went in for my first fill the port was flipped AND detached.. there was no way to turn it over to put the saline in so I can actually use the lapband device... What tricare is stating is that the FDA has no factual information that the 2nd(revision tot he port surgery) is necessary to make the lapband work...

I had an MGB done as a revision surgery after a failed sleeve gastrectomy. So far (2 months out) I'm doing very good and I'm really happy with the procedure. My main concern with the MGB is GAS. Really bad, bad, bad GAS problem. I have red in a MGB dedicated forum about it and as far I know there is nothing you can do. If there is someone that can help....please jump in!

I'm glad you're recovering well. Keep us posted on your progress with the revision.

Today is two weeks past surgery. Recovery has gone well with no complications. My surgery was a revision from sleeve to bypass for hernia and GERD issues. I've dropped 10+ lbs in the two weeks which seems right in line (I was only at 227 on date of surgery). Per my surgeon's plan today we could progress to soft solid proteins, so it was great to have an ounce or two of sliced deli meat for lunch. Only downside is that they do an internal stitch to hold things together and that pain is real. I'm told it'll go away 4-6 weeks following surgery but until then it's the only downside to an otherwise good recovery so far.

Please keep me posted on how you're doing. I'm also a patient at PNC -Methodist. Have you gone to any of their support groups on Wednesday evenings? I had lap band and now starting the process of revision to sleeve. I just handed in my packet of info yesterday....ready for a new chapter.

We understand very well what a DS is, what you said is you wanted to know if someone had a VSG and a DS at the same time. Since you know so much about it you should know that the DS itself includes the VSG component, therefore someone either has a DS, or they have a VSG, they do not have "both", it's implied that the VSG is included in the DS as that is what the procedure is. You never hear someone say "I had a VSG and a DS on March 15". No, if they previously had a VSG then they had a revision to a DS. Not, as you stated "I'm asking if anyone had both at the same time, in Mexico." You're very condescending and it's really not warranted.

I am having revision bypass after 2 years of having the sleeve. I lost and have kept off 100 lbs. can anyone give me an idea as to how much more I will lose. Went from 239 to 139 and wearing 6s!!

Like others have said, it does depend on your health issues. I was in the same predicament when I started this process, being told that either surgery would be good for me. I started the process wanting the sleeve because the bypass seemed too intrusive what with your anatomy being changed. However, I’m a week post op with gastric bypass and I wouldn’t change anything. I chose bypass over sleeve due to more weight on average being lost, and more success with it. I see a lot of people with sleeve getting a revision to bypass. Either surgery can be extremely successful, but my research led me to bypass.

I had a sleeve in 2017 and told my best work friend and parents. When I started losing weight so rapidly, people thought I was dying, like from cancer or something. And I had no idea until said work friend came to me and was like “this is getting out of hand, how have you not heard anything, say Something!” Ha. Now I’m doing a revision to bypass and I am shouting it to the world. I’m so excited! And definitely want no one to think I’m dying!

I just had an awesome consultation for revision! My doctor doesn't think I'm going to have any issues with approval from Anthem BCBS. I have to do a few classes next week and then she'll submit for pre-approval to see if we're up against any roadblocks. After that I need an upper endoscopy and some nutritional classes but not much else! She said it would probably be 3 to 5 months before surgery. I'm hoping for closer to the 3 months because I'd like to be all healed up and fairly adjusted to the new lifestyle before we go camping all summer! [emoji846] Sent from my SM-N975U using BariatricPal mobile app

USC doesn't do banding, but they DO charge $800 for their program fee for support for RnY/DS surgeries. My surgeon charges $2000 ($3000 for revision patients) for his "weight loss program fee." Interesting enough, those fees are now tax deductible...as long as you have (well...in my case...a Letter of Medical Necessity stating that the program is for the treatment of a disease such as obesity or hypertension. which should be here soon so I can "ransom" my three grand out of my Section 125 account.) However, when we go into the area of pre-paid follow-up we get iffy, because pre-paid medical is NOT deductible...but, the support groups, dietary advice, education, etc. are all okay.

Good Luck Jules...I went to Mexico also...twice, once for the band, then for the revision when my band crapped out. Glad to have you here. Aetna, I have them, don't get me started, I didn't even bother trying. I'm 3 months out and lost 46 pounds with little to no effort....you'll LOVE LOVE LOVE IT!!

stcyt I'm almost 3 months out from my revision and my scars are very minimal. I had the lap band done one year ago, so I have double the scars. But they are all just little silver lines. Some of them are no bigger than my pinky nail. I'm 50 years old and I will probably wear a 2 piece swimming suit again!!! Good luck, and happy losing!