Lightweight revision BMI

[Kristaz]

For any of your lightweights that have had a revision what was your BMI at the time of the revision? What did you revise from/to? Trouble with getting insurance to cover with a lower BMI?

 

[DSRIGGS]

My revision was to extend my channels because of malabsorption but my BMI was about 22.5, so it wasn't really justifiable by just BMI (opposite of what you are trying to accomplish). That being said my revision was approved for health reasons of malnutrition. Can you use health issues for the justification. I am pretty sure Dr K submitted me as an exploratory lap and I was approved. Just a thought.

 

[Marquis Mark]

I was a little under a 37 BMI at revision time. Went from a sleeve to the DS. Kaiser didn't give me any crap about it. In my experience, most things at Kaiser are pretty doctor dependent. If you have a good relationship with the doctor, you can pretty much get anything, as it seems Kaiser will pretty much go with whatever their doctors recommend. That's they way it's worked for me anyway.

One time my doctor wouldn't do what I wanted so I just switched my PCPs. The next one was fine with it. problem solved.

 

[Kristaz]

My revision was to extend my channels because of malabsorption but my BMI was about 22.5, so it wasn't really justifiable by just BMI (opposite of what you are trying to accomplish). That being said my revision was approved for health reasons of malnutrition. Can you use health issues for the justification. I am pretty sure Dr K submitted me as an exploratory lap and I was approved. Just a thought.

Yeah. So far so good. They want a few test etc then we will submit. Dr K said absolutely medically justifiable but insurance can be ridiculous. My BMI is low about 30ish. But not looking for weight loss ( would be an added benefit!) but looking to fix the dumping. So my fingers are crossed that they will approve for the medical necessity.

 

[Kristaz]

I was a little under a 37 BMI at revision time. Went from a sleeve to the DS. Kaiser didn't give me any crap about it. In my experience, most things at Kaiser are pretty doctor dependent. If you have a good relationship with the doctor, you can pretty much get anything, as it seems Kaiser will pretty much go with whatever their doctors recommend. That's they way it's worked for me anyway.

One time my doctor wouldn't do what I wanted so I just switched my PCPs. The next one was fine with it. problem solved.

Yeah! We have to be our own advocates. My first surgeon is no longer practicing and the reccommend guy in my area basically brushed me off... So that's when I went in my own search and found Dr K. I have Blue Cross so we shall see how they are.

 

[Marquis Mark]

Yeah! We have to be our own advocates. My first surgeon is no longer practicing and the reccommend guy in my area basically brushed me off... So that's when I went in my own search and found Dr K. I have Blue Cross so we shall see how they are.

I had a consult with Dr. K. I liked him, but using him would have meant switching my plan to Blue Cross for a year and likely still paying about $12,000 out of pocket (compared to my $100 surgery fee for the DS at Kaiser). Wasn't sure what to do, but after I grilled Dr. Belzberg (and he me) I was super comfortable with him doing the surgery (31 years of GI/bariatric surgical experience and he's performed every surgery from the breastbone to the pelvis - including really complicated stuff that other doctors can't handle). My sleeve was done at Kaiser six years prior by another guy in that department, so I think he just wanted me to really have a good outcome this time.

So far, I think I made a good decision. In general, I really like Kaiser and it would have been a major hassle to transfer to BC for year.

Good luck. I think if you can get Dr. K to write you a good letter, you'll be OK.

Best, MM

 

[DSRIGGS]

I had a consult with Dr. K. I liked him, but using him would have meant switching my plan to Blue Cross for a year and likely still paying about $12,000 out of pocket (compared to my $100 surgery fee for the DS at Kaiser). Wasn't sure what to do, but after I grilled Dr. Belzberg (and he me) I was super comfortable with him doing the surgery (31 years of GI/bariatric surgical experience and he's performed every surgery from the breastbone to the pelvis - including really complicated stuff that other doctors can't handle). My sleeve was done at Kaiser six years prior by another guy in that department, so I think he just wanted me to really have a good outcome this time.

So far, I think I made a good decision. In general, I really like Kaiser and it would have been a major hassle to transfer to BC for year.

Good luck. I think if you can get Dr. K to write you a good letter, you'll be OK.

Best, MM

I am BCBS and even though plans vary (I have never heard of better plan than this one my wife has) I am sure they will cover her revision out of medical necessity. Dr K's office is very good in getting these procedures approved and will find the proper verbiage to make it happen.

 

[Onelastshot]

I have Independence Blue Cross in PA and originally had the lap band. I did very well with it but had complications and needed to have it removed. My BMI skyrocketed to 44.6 but since I had none of the other traditional co-morbidities, insurance fought me tooth and nail. I went through 3 levels of internal denials and then an external review and won to have RNY (thanks to the help of Diana and Lorraine). Upon even further research though I decided to go with the DS. Problem was that my RNY doc did not do the DS so I had to start all over again. When I found doctor Greenbaum he didn't think approval would be an issue since I already went to an external review and won. As I applied for surgery though Dr. G's staff said the insurance company kept coming back to them asking more questions than they ever have and giving them a really hard time. I lost it. I told them to quote me. "You tell those sons of b*tches at Blue Cross that I have already fought through 4 rounds of appeals and won. I will fight again. I will fight as long as I need to, only this time WHEN I win I will post in every bariatric surgery forum exactly how I won." Now I am not saying my rant had anything to do with it, but I was approved 2 days later. And it felt damn good.

Long story short, FIGHT! They want you to go away. Don't!