Will I likely qualify for revision since my weight has been hovering from BMI 30-35 for 2 years?

Carl S.
on 5/5/14 2:10 pm
with

Will I likely qualify for a revision to RNY gastric bypass since I had the lap band 2+ years ago and my BMI always stayed obese between 30-35 for 2 years? I did exercise, food diet, weight lifting, etc

My insurance is Health Net. They specify 2 years of BMI 35 for those who never had surgery. They don't mention requirement for revision.

 

 

 

Judy700
on 5/5/14 5:40 pm
VSG on 03/11/14 with

I don't know the particulars of your insurance or what goes into coverage for a revision, but just about all insurance companies require you to have a BMI of 40 or above or have comorbidities if you are between 30 and 35.  Some insurance companies even require you to have 2 comorbidities.  They are pretty particular about which comorbidities will qualify, but they are the major ones like diabetes, sleep apnea, cadriomyopathy, etc.  That part is pretty standard across the board.  I know some people who don't meet that criteria choose to self-pay.  I suggest you call your insurance company first and ask them if they will cover a revision and whether or not you meet their criteria.

Good luck!

VSG on March 11, 2014. 60 yo female from Washington, DC area. 

HW: 235  SW: 230  CW: 134.5 (3/23)    M1:-19    M2: -13   M3: -10.4    M4: - 8.2   M5: -6.4    M6: -5    M7: -7.4    M8: -4    M9: -8.6    M10: -5    M11: -3.6    M12:  -1.5 Goal reached 3/23/15 in 1 year + 12 days following surgery.  BMI from 42.1 to 23.9 

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

MsBatt
on 5/6/14 1:01 am

You'll just have to call and ask. Some companies have started having a 'one per lifetime' clause on WLS, alas.

 

Sparklekitty, Science-Loving Derby Hag
on 5/6/14 1:48 am
RNY on 08/05/19

Every insurance company has different requirements. The only way to know for sure is to contact HealthNet directly, give them your ID number, and ask them directly.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!

Carl S.
on 5/6/14 4:35 am
with

Cool. I contacted my surgeon and they said they will do everything to get me qualified to get the revision done. I am awaiting to get this done by early 2015, I'll keep you guys posted.

Also, doesn't it sound good that I can change to 4 different insurances in a matter of weeks?

I think there are a few who did lap band, were not satisfied with the pounds and they decide on a revision. There are folks who do gastric bypass, lose like 90% EWL but then regain it a few years later.

Isn't that crazy? After gastric bypass they say if you don't eat right your pouch stretches back to where it was!

poet_kelly
on 5/6/14 5:34 am - OH

Who says that?  It is possible, though it doesn't happen often, for the  pouch to stretch more than it's meant to.  But it would be physically impossible for it to stretch to the size the old stomach would. 

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

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