Revision denial by Anthem BCBS

[dazedinks 10]

After 4 months of crossing off requirements for my surgery center and my insurance company I was denied. The reason was one weight loss surgery per lifetime. That sounds pretty final to me. Has anyone else had this happen and then was approved after an appeal? My lapband kept tightening on me and then I would have to get an unfill then refill and repeat. The last time when i was getting refilled I developed GERD and could not get filled to proper restriction because the GERD was too awful. Thank you in advance with any info.

Jen

[Djmohr 6,965]

I would ask your surgeon to do a peer to peer review with your insurance company. They know exactly how to get around it if in fact it is possible.

My insurance company said the same thing only one per lifetime.....thankfully I chose bypass in the first place so hopefully i will never have to worry about it.

But I would ask your surgeon to push back given your complications.

[krisk12786 29]

I have anthem BCBS. I was just approved for a revision to gastric bypass due to gerd and esophageal dismotility

[CurvyCakes 269]

After 4 months of crossing off requirements for my surgery center and my insurance company I was denied. The reason was one weight loss surgery per lifetime. That sounds pretty final to me. Has anyone else had this happen and then was approved after an appeal? My lapband kept tightening on me and then I would have to get an unfill then refill and repeat. The last time when i was getting refilled I developed GERD and could not get filled to proper restriction because the GERD was too awful. Thank you in advance with any info.
Jen

Jen I suggest having your surgeon do a peer to peer review with your insurance company. Many that were denied were able to get approved after the peer to peer. Sometimes coding is an issue too. Although bypass is a weight loss surgery revision most times isn't for weight loss but more so to fix a complication of surgery itself. Best of luck to you. Severe GERD is no joke!! I'm being revised from sleeve to RNY due to GERD. I have BCBS as well.

[dazedinks 10]

My surgeon appealed and I have been approved! I go next Monday, March 27 at 2pm to hopefully get a surgery date!! So happy.

[CurvyCakes 269]

That's awesome. Keep me posted. I swear this is such an emotional roller coaster. One moment I'm excited the next scared out my mind of all the worst possibilities. Never imagined I would need a revision.