A little background on me. I had VSG in 6/2009. Lost 110lbs in about 7 months. Was feeling great but unfortunately I never met my goal. By my 1 year anniversary I started to gain back all the weight. Fast forward to today and I've gained 80lbs back! I feel like such a failure! I'm looking into get the DS and have been doing research off and on for the last 2 years. I spoke with my insurance yesterday and gave them the procedure codes and they were all approved. She stated I need 6 months of doctor monitored diet and psych eval (basically all the same stuff I needed the first time). I'm not a hundered percent sure she understood that I was wanting a revision and that this wouldn't be my first weight loss surgery. I'm wondering for those that had a revision what insurance required of you. I have BCBS of MI
VSG to DS
- Thread starter TressaSos
- Start date
You are not a failure...you had a surgery that failed you.
If you are in MI, the only DS surgeon is Dr. Kemmeter http://www.grandhealthpartners.com/
If you are in MI, the only DS surgeon is Dr. Kemmeter http://www.grandhealthpartners.com/
So I called BCBS back and made sure they understood it would be a revision. The gentleman that I spoke with told me that I did not have to do the 6 months doctor monitored diet or psych. I need a pre-auth from surgeon/PHP and documentation why the surgery is medically necessary. I have contacted my husbands HR department to get a copy of the EOC, which they gave me a number to contact the underwriter. Was unable to speak with someone but left a message. Will try back later today. Thanks!
Neither opinion of BCBS flunkies of what your revision surgery requirements are is worth the paper they WEREN'T written on. You need to find out what YOUR policy is, and what bariatric requirements apply to YOUR policy, and then get your bariatric surgeon (Kemmeter, I hope) to submit for preauthorization, and preferably have him cite what your requirements are and that you have met them.
Make sure you get names and titles of each person you speak to at BCBS, and write them down, along with the date and time of the conversation and a summary of what was said. NONE of that is binding on BCBS, but it can build your case that they are not dealing with you fairly, should you need to get to external review.
Make sure you get names and titles of each person you speak to at BCBS, and write them down, along with the date and time of the conversation and a summary of what was said. NONE of that is binding on BCBS, but it can build your case that they are not dealing with you fairly, should you need to get to external review.
Larra
Well-Known Member
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- Dec 31, 2013
- Messages
- 3,524
What @DianaCox said - you've already found that two different people told you two completely different versions of what was required, and for all we know they could both be wrong. No one cares about this more than you, and when some low lever customer service rep misinforms you (as at least one of them did) there is no penalty for them. So it's incumbent upon you to read your EOC and know the policy for yourself.
And document, document, document.
And document, document, document.
