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BCBS revision requirements



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I am looking for revision due to GERD and a little weight gain back from sleeve. My GERD is so bad I have been waking up choking on it. I called BCBS to ask them their requirements and the woman referenced me to a page in the book that clearly states NOTHING about revision requirements. I’m miserable. The dr office won’t even look at me u til I find out if revision is covered by my insurance and they simply just won’t give me a yes or no answer.

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I have BCBSTX and needed revision due to GERD and was approved. My plan had a $3,000 copy for Weightloss surgery so that is what my out of pocket was.

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The general industry practice is, assuming that there isn't any "1 WLS per lifetime" restrictions, is that for regain or inadequate weightloss problems, the same basic BMI rules apply (40 or above, or 35 with comorbidities).

With a complication such as your GERD, however, it is no longer considered a "revision" as a surgery addressing the complication. The policy bulleting on WLS for your policy may or may not be that specific in this case, and you need to get a reading from the insurance company for you specific circumstance.

Your surgeon's office should have an insurance coordinator on staff who handles all of this, as they know the language and the in's and out's of the system. Since it is how they (the doctor's office) get paid, it really is their job to do so. Perhaps there is another surgeon in your area who has a better business office? Assuming that the original surgery was covered by insurance, a complication such as this is usually covered as well.

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