I am seeking RNY to DS revision. Aetna HMO (Phoenix)
When Bariatrics is on the list of exclusions on your policy does that generally include revision surgery or are those 2 separate things? I am working on getting the full policy document from my husband's employer but I don't have it available yet. The policy summary lists bariatrics in the exclusion list but then under that, it says: "covered when medically necessary" and includes a list of criteria for revision surgery (not virgin WLS). I called HR and Aetna but I am not confident in the information I got over the phone. (They both said they do not see any exclusions in the policy for Bariatric surgery and I would have to just meet the criteria for the procedure and get a pre-approval) Then why would the summary clearly have it listed under exclusions? I'm so confused.
I am pretty pessimistic but is it possible that it means they will look at each case individually to determine coverage for revision surgery?
One doctor's office I spoke to, Dr. Simper's office, I was told they are separate things and just because one is excluded doesn't mean the other is not covered. That office won't take me on as a patient because my original surgery (RNY) was in MX. They said they would call back if one of the Drs in the office decided to make an exception for me. Never got a call back. Dr. Simper is retiring and won't do an RNY-DS anymore anyway and I don't want an inexperienced surgeon who wants to experiment on me anyway.
I also contacted Dr. K in CA. I submitted an inquiry on the website which included my insurance info. I got an automated email saying they would get back to me with more info within 2 days. It's been 3 days and I have not heard back from that office either. Bad sign? Just be patient? I emailed them this morning to see what's up.
My next contact is Dr. Ayoola in Texas. I have not reached out yet. He allows the patient to set up an appointment on the website but I think it is a better idea to call directly and see if they would be willing to check on my insurance before I make the trip to see him. Although, I would be glad to get a thorough evaluation from Dr. A to see why I am having all of the pain and other symptoms that have been getting gradually worse and worse. Even if insurance won't cover the revision, I still want to know what is wrong with my current surgery before it becomes an emergency situation, right? Local doctors don't know much about WLS or WL surgeons won't see me even for an evaluation because I was not originally their patient. The ones I have seen are looking for new patients not old patients with potential problems and I can't blame them, really.
Besides getting the full insurance policy agreement, what else can I do? Does anybody know of a WLS in AZ that would be willing to look at me just for evaluation (not necessarily a revision? That would save me the travel expense if insurance won't cover revision. I have had the worst luck finding post-op care in the US, unfortunately. As my symptoms keep getting worse I am getting more and more nervous that after 13 years with the RNY something is not right.
Thanks you for any advise!
When Bariatrics is on the list of exclusions on your policy does that generally include revision surgery or are those 2 separate things? I am working on getting the full policy document from my husband's employer but I don't have it available yet. The policy summary lists bariatrics in the exclusion list but then under that, it says: "covered when medically necessary" and includes a list of criteria for revision surgery (not virgin WLS). I called HR and Aetna but I am not confident in the information I got over the phone. (They both said they do not see any exclusions in the policy for Bariatric surgery and I would have to just meet the criteria for the procedure and get a pre-approval) Then why would the summary clearly have it listed under exclusions? I'm so confused.
I am pretty pessimistic but is it possible that it means they will look at each case individually to determine coverage for revision surgery?
One doctor's office I spoke to, Dr. Simper's office, I was told they are separate things and just because one is excluded doesn't mean the other is not covered. That office won't take me on as a patient because my original surgery (RNY) was in MX. They said they would call back if one of the Drs in the office decided to make an exception for me. Never got a call back. Dr. Simper is retiring and won't do an RNY-DS anymore anyway and I don't want an inexperienced surgeon who wants to experiment on me anyway.
I also contacted Dr. K in CA. I submitted an inquiry on the website which included my insurance info. I got an automated email saying they would get back to me with more info within 2 days. It's been 3 days and I have not heard back from that office either. Bad sign? Just be patient? I emailed them this morning to see what's up.
My next contact is Dr. Ayoola in Texas. I have not reached out yet. He allows the patient to set up an appointment on the website but I think it is a better idea to call directly and see if they would be willing to check on my insurance before I make the trip to see him. Although, I would be glad to get a thorough evaluation from Dr. A to see why I am having all of the pain and other symptoms that have been getting gradually worse and worse. Even if insurance won't cover the revision, I still want to know what is wrong with my current surgery before it becomes an emergency situation, right? Local doctors don't know much about WLS or WL surgeons won't see me even for an evaluation because I was not originally their patient. The ones I have seen are looking for new patients not old patients with potential problems and I can't blame them, really.
Besides getting the full insurance policy agreement, what else can I do? Does anybody know of a WLS in AZ that would be willing to look at me just for evaluation (not necessarily a revision? That would save me the travel expense if insurance won't cover revision. I have had the worst luck finding post-op care in the US, unfortunately. As my symptoms keep getting worse I am getting more and more nervous that after 13 years with the RNY something is not right.
Thanks you for any advise!
