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Sleeve to DS Insurance question



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I had the sleeve in 2013 and am in the process of looking to revise to a DS. I am extremely worried about the insurance portion. I know "everyone's insurance is different" I get it. Having been through the insurance stuff before I do realize it's case by case etc. I have Aetna and I did read the policy jacket and all that.

I just want to know is there anyone on here that was approved for a second surgery and if so what is your story? I have had a little regain but been stalled over a year and a "twisted" sleeve it looks like cobblestones on top of each other. My BMI is 37. NO COMORBIDIES (sp?) Has anyone been approved in a similar situation?

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I had my sleeve done in August, 2013, & then had a revision of the sleeve & conversion to a single-anastomosis duodenal switch December 29, 2015, all covered by Aetna.

I still had the co-morbidities I did before the first sleeve, some improved, some not, & my BMI was just over 35 at the time of my revision consult. I believe my surgeon also used the argument that my highest recorded BMI was just over 50 before the first sleeve.

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This topic came up last month in our support group meeting, and the surgeon said that in this woman's case, like yours, it is usually considered to be treating a complication of the original surgery, so the BMI requirements don't apply. Like always, its a YMMV thing between companies, but that is how it is generally handled.

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