Advice on Insurance Approval Process for Revision From Band

[bandtosleeve]

I wasn't sure I liked when the nurse said they first get approval for removal and then approval for a "new" surgery. I'm no longer in the category that I qualify as a new bariatric patient. So in addition to hearing about my docs sleeve leaks (2 in about 100--unsure if they were revisions or original surgeries), now I get the impression they aren't used to the insurance process for a revision. I'll call my insurance, but just checking to see if anyone has done it. I have Aetna and was approved quite quickly for my initial band surgery (2008).

[Anamor2011]

I recently had lapband to sleeve revision but mine was not done at the same time. It will all depend on your surgeon. I had my band out in October and my sleeve done in December, my doctor said I had to wait at least 6 weeks in between surgeries. She said there is a higher risk of complications when they are done at the same time. I also called the insurance to ask about that, and they stated that dr could have submit for both to be done at the same time. Insurance will cover it, is just up to your surgeon to decide who they want to do it. My BMI was right at 35 when I submitted for insurance to approve and I was approved,I also have Aetna ins. Per my AEtna guidelines, if I remember correctly you have to have a BMI of 35 or over for the revision surgery and have other medical complications. So my doctors submitted all my documented visits with the extreme port pain, and port revisions I had, plus all the vomiting and weight gain I had. You do also have to have some of the pre surgery requirements as before, I had to do one Psych visit and 1 dietician visit. You might just need to go on your insurance website and find out what the requirements are for WLS revision.

[bandtosleeve]

I just want it to be clear that it's a revision from the get-go. On the Aetna site, I did see that they will approve a lap band revision due to complications (I had a dilation of the pouch which corrected itself upon a complete unfill and was just able to get another small fill to try and stop gaining...). I didn't see any BMI requirements for complications--although I think mine is back to 35 anyway...up from 30 (just 20 pounds does that!). I just don't want the office to only put in for the removal and then later the "new" surgery get denied because I have no co-morbidities (well except GERD). He will do it in 1 procedure ONLY if the stomach is in perfect condition with no scar tissue. I just didn't get the impression he has done that many sleeves (maybe 100 and had 2 leaks), and barely and bands to sleeves. I do know my doc wants to remove it first, wait 3 months and then do the new procedure. I'm also afraid that if I had a dilation with the band, will I have one with the sleeve (since I know it can stretch). Ugh...I want this to be my final WLS.