Will FEP bcbs cover revision to bypass due to Gerd and hiatal hernia

[clrobinson2014 0]

I had sleeve Jan 2014. Went from 266 to 176, then gained 25 back from having 2 babies. I just went to a gen. Surgeon to discuss getting an umbilical hernia fixed and we also discussed my severe acid reflux. He ordered an upper GI which showed Severe Gerd and a small hiatal hernia as well. He put me on meds which aren’t helping much. He said the only way to properly fix the issues is to revise to a bypass. I now have an apt with a bariatric surgeon to discuss options. Will FEP bcbs cover the revision if I havevto have one? Will I have to go through the same process as when I had sleeve done? Will I have to meet same requirements? My BMI is only 31.4. I would really be getting the revision done due to Gerd and to fix hernias.

[Matt Z 4,138]

Revision for issues of this nature are typically covered. But it's all doing to depend on your specific plan, not all FEB BCBS is the same.

My revision required a few extra hoops to jump through, but I also have a different provider now than I did when I was banded. But they still approved the revision, I had stage 4 esophagitis and didn't even know it.

Good Luck!

[ahillig 136]

According to the FEP BCBS benefits guide this is what is required for revisions:

•Benefits for subsequent surgery for morbid obesity, performed on an inpatient or outpatient basis, are subject to the following additional pre-surgical requirements:

- All criteria listed above for the initial procedure must be met again, except when the subsequent surgery is necessary to treat a complication from the prior morbid obesity surgery .

- Previous surgery for morbid obesity was at least 2 years prior to repeat procedure

- W eight loss from the initial procedure was less than 50% of the member’s excess body weight at the time of the initial procedure

- Member complied with previously prescribed post- operative nutrition and exercise program

- Claims for the surgical treatment of morbid obesity must include documentation from the member’s provider(s) that all pre-surgical requirements have been met

[SlimChickadee 219]

I had my barium swallow test today and the doctor that was present stated he saw a small hiatal hernia and asked if I was on medication, I told him I was for the Gastric Reflux and he said, "Well, they will probably just change your medication!" I am so hoping this do not deter me from getting approved for my lap-band (banded since 2009) removal as well as my revision to Roux en y procedure later. I was told my insurance covers 90% but hope I am approved to have it done. Haven't heard from my Bariatric surgeon's office yet but again only had the swallow test today. #keepingfingerscrossed. Can anyone tell me how long it took for the approval. Also had my first nutrition visit today as well and I was told I have to contact a psychologist for an eval. So, why would I have to go through all of this if I am not going to be able to have the surgeries?

[SeattleLady 277]

I had my barium swallow test today and the doctor that was present stated he saw a small hiatal hernia and asked if I was on medication, I told him I was for the Gastric Reflux and he said, "Well, they will probably just change your medication!" I am so hoping this do not deter me from getting approved for my lap-band (banded since 2009) removal as well as my revision to Roux en y procedure later. I was told my insurance covers 90% but hope I am approved to have it done. Haven't heard from my Bariatric surgeon's office yet but again only had the swallow test today. #keepingfingerscrossed. Can anyone tell me how long it took for the approval. Also had my first nutrition visit today as well and I was told I have to contact a psychologist for an eval. So, why would I have to go through all of this if I am not going to be able to have the surgeries?

I was told max 2 weeks.

Sent from my SAMSUNG-SM-G935A using BariatricPal mobile app

[SeattleLady 277]

Sent from my SAMSUNG-SM-G935A using BariatricPal mobile app