What insurance companies cover DS revision

Discussion in 'Insurance' started by Trilla, Oct 19, 2018.

  1. Trilla

    Trilla Member

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    I am looking for an insurance company that will cover a DS revision.

    I'm looking for options since I was denied twice by BCBS of IL.

    Thanks
     
  2. hilary1617

    hilary1617 First time at the rodeo.

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    Hi, Can you confirm if you are seeking a conversion to DS from another procedure, and if so, which one? Or are you seeking some form of revision post-DS?
     
  3. Trilla

    Trilla Member

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    I had a RNY in 2005.
    I want to get a revision to a DS.
     
    Angelina Frazier likes this.
  4. Larra

    Larra Well-Known Member

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    There are a gazillion insurance policies out there. You would need to figure out what policies are potentially available to you, and then see if you can get info regarding whether or not they cover revisional bariatric surgery at all (many don't) and THEN figure out what their criteria are for revisions (often more stringent than for a primary bariatric operation) and THEN figure out if they covef revisions specifically to the DS...you get the idea. This isn't something we can sort out for you, you need to do some research yourself. AND, don't trust anything someone tells you over the phone (yes of course we cover bariatric surgery!) because that doesn't mean you will be covered for the very specific operation you want.
    Of equal importance, most DS surgeons don't do revisions of RNY to DS, because it's a complex, challenging operation with a significant rate of risk. I say this not to discourage you, but to advise you that you need the right DS surgeon, and you may need to travel, as many people do for this type of revision. If you can accept that reality now, it will help. There is a list somewhere on this website of the surgeons we know of who do these revisions.
     
  5. Trilla

    Trilla Member

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    Thank you.

    I have seen the list of surgeons that are experienced with doing a revision. I picked Dr. Ayoola who is in texas (I live in Illinois, so I understand the travel aspect). I have BCBS of IL who has denied me twice. Even though I have a BMI over 50 and I had a technical failure with my RNY.

    However, you did give me an idea.

    I will reach out to Dr Ayoola's office and ask Yajaira whose insurance they accept. At least it will give me some companies to research.

    But I am still hoping people who have gotten an RNY revision to DS could share the name of their insurance company so I can be relatively confident the company covers the procedure.

    As you mentioned there are a ton of companies out there and that would help me narrow the list tremendously.
     
    Angelina Frazier likes this.
  6. southernlady

    southernlady Administrator Staff Member

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    Regardless of which company they accept, your employer can always opt to exclude WLS. That’s another path to check as well.
     
    Angelina Frazier likes this.
  7. Shawnee

    Shawnee Member

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    Hi!! I just had a RNY to DS surgery on Tuesday with Dr. Greenbaum in NJ. My surgery was fully covered except for my deductible. My insurance is Capital Blue of Pennsylvania, which is just Pennsylvania’s version of BC/BS. My Dr office submitted it and they approved me on the first try!! Believe me when I tell you, you could have knocked me over with a feather on that one!! I was sure I would be denied. Good luck on your journey, just keep on trying!!
     
  8. Trilla

    Trilla Member

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    Thank you
     
  9. southernlady

    southernlady Administrator Staff Member

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    BC/BS along with almost every major player (Cigna, UHC, etc) covers surgery BUT, your employer can opt to not offer the coverage.
     
    Angelina Frazier likes this.
  10. Shawnee

    Shawnee Member

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    Yes that’s true certain employers can opt out of that type of surgery!
     
  11. Spiky Bugger

    Spiky Bugger Well-Known Member

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    Insurance companies tailor policies to what the buyers (employers, usually) want to spend.

    How about...IS YOUR INSURANCE THROUGH AN EMPLOYER? Do you have other options via your employer?
     
    JackieOnLine likes this.
  12. DianaCox

    DianaCox Bad Cop

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    You still should pursue an appeal to external review of your current denial. Might be the quickest way - though I realize the timing sucks because it’s currently open enrollment.
     
  13. Angelina Frazier

    Angelina Frazier Angiebaby73

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    Good luck to you. I met with Dr. Ayoola earlier this year. I had a rny in the past (over 15 yrs ago) and want to have DS with Ayoola without a doubt. However my jobs insurance does not cover it. If u find any companies that cover it, please share.
     

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