What are the insurance requirements to cover a second gastric bypass? - ThinnerTimes

lislog · 05-29-2008, 08:43 AM

A friend of mine had GP several years ago. Just went for her eval to have a second one. Dr told her that she is a good candidate but results did not reveal any leakage from old one. Has hypertension & diabetes. What else needs to be in the letter to make sure that the insurance will cover it? Thanks in advance.

BabyNicole · 05-29-2008, 09:06 AM

All insurances require different things. I'd encourage your friend to call or look online. I'm sorry she needs another one. Did she ever think about a revision to the stoma instead?

lislog · 05-29-2008, 09:14 AM

Where specifically does she need to look online. I know insurance companies don't just freely advertise there checkllists for coverage. This site was our starting point. Thanks.

BabyNicole · 05-29-2008, 09:19 AM

Quote:

Originally Posted by lislog

Where specifically does she need to look online. I know insurance companies don't just freely advertise there checkllists for coverage. This site was our starting point. Thanks.

I was refering to her specific insurance company online. I have Oxford, and I go to benefits section and it lists everything I have to get. It's always good, though, to speak to someone to see if your specific company has any exclusions. Some exclude WLS all together. Now, if she has the same company that she originally had the bypass with, I wouldn't see why they'd cover it again (not saying they shouldn't, just saying they may not). If it's a new company, they might. But I'm sure they'll want to know why it didn't work for her in the first place and why it'd work now. You know? Insurance companies can be tricky. Good luck to your friend, and I hope you can get more specific answers from someone on here who went down that road before.

nextbigloser · 05-29-2008, 09:30 AM

Why is there the need for a second surgery, why was the first one unsuccessful to the point of needing another surgery?

soon2bthin · 05-29-2008, 09:33 AM

Good question Kim I was wondering the same exact thing?

nextbigloser · 05-29-2008, 09:35 AM

I'm concerned that it may be self discipline. You have to change your life style not just have the surgery. You are giving a tool and its our job to make the most of it.

lislog · 05-29-2008, 09:37 AM

I'm not exactly sure. This is a relatively new friend and I don't know all of the details. I don't know if she lost all of the weight initially then gained some weight back or only lost some. I'm just trying to do research so she can dot all of her i's and cross all of her t's to amke sure that her insurance pays for it if they are going to. also mom & dad both died in their 50's of heart disease.

nextbigloser · 05-29-2008, 09:39 AM

She still has the tool to use. I would suggest she find a support group and start attending. Do a search for the 5 day pouch test she could start out by trying that.

lislog · 05-29-2008, 09:45 AM

I know she suspected leakage ---that's why she went back to the doc. She seems very disciplined to me but you never know. We will see. Thanks for the input.