Revision Denied
I have Athem BCBS based in Ohio. I was denied a revision from lapband to RNY, because the company my husband works for has a limit of 1 weight loss surgery a lifetime in place. I was unaware of this at the time of my lapband.
As I am over 65, in January, I will be switching insurance's to medicare. I have been told that medicare will approve it. Does anyone have any imput on this?
As I am over 65, in January, I will be switching insurance's to medicare. I have been told that medicare will approve it. Does anyone have any imput on this?
(deactivated member)
on 5/11/12 12:43 am - WA
on 5/11/12 12:43 am - WA
I have Medicare and it covered my initial surgery now 4 years later it will cover the revision. Medicare doesn't have a limit on how many you have. You must be at least 35 BMI and have at least one comorbidity. Failed previous weight loss attempts (your lap band), Surgery must be in Center of Excellence. These are the only requirements there are for Medicare. Medicare will cover 80%, But they do not cover NUTS. You may be able to get Medicaid to cover the other 20%. Medicare only covers RNY, Lap Band and BPD-DS. Surgerys are not looked at as a revsion just simply a surgery .
Medicare does not pre authorize but the surgeons know that if they follow the requirements the surgery is covered.
Medicare does not pre authorize but the surgeons know that if they follow the requirements the surgery is covered.
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