How To Get Insurance To Pay For Gastric Bypass Revision?

Over the last four years, the field of weight-loss surgery has grown at an exponential rate. As a result, I’m receiving an increasing number of questions about post-operative surgery. The sheer quantity of post-op patients is boosting the demand for these two sorts of post-op operations, whether it’s plastic surgery or a revision.

The word “revision” means “to change or amend” (for our purposes, it is to change or modify a prior bariatric surgery). Revisions are possible in a number of areas. A patient will either be undergoing a revision of a failed bariatric procedure or undergoing a revision to a new type of technique that was not approved or even available at the time of the original surgery.

This is a basic question with a more complicated answer. Insurance firms, as we all know, appear to make choices by tossing darts at a dartboard. As a result, it’s only normal to suppose that a supplier will respond differently to various people from different states.

To begin, a request for a revision based on a failed prior bariatric surgery would elicit a response from most insurance providers, who will query whether the earlier surgery genuinely failed or whether the patient was just not adhering to the initial operation’s guidelines. To put it another way, you’re eating past the pouch or band.

Similar questions will be asked about a revision from a previous treatment to a new type of procedure, as well as why the patient wants to transition from a Roux-en-Y to gastric banding or duodenal switch.

It’s critical that you and your surgeon are on the same page before making such a request. He or she should be aware of the specific reason for the operation, as well as any challenges you had with compliance during the initial process. Never wait for the insurance company to inquire about the matter. When your surgeon sends a request for authorization, respond to it.

If the pouch stretched, the staple line failed, the band slipped, or the bypass just didn’t work, you’ll need pre-op testing to back up your claims. You should obtain the results of an MRI, CT scan, or endoscopy before applying for certification. Similarly, you should give the surgeon a basic summary of your compliance throughout time, including a diet and exercise history.

It’s likely that your BMI has been low in the past and that you no longer have any substantial co-morbidities. In this situation, you’ll make sure the carrier understands that if the modification is denied, it’ll only be a matter of time before your BMI becomes even higher and your co-morbidities resurface. If you’re requesting a new type of surgery, one that didn’t exist when you last had one, make sure to highlight the reasons why this operation is suited for you in your surgery request. By answering the insurance company’s questions before they’re asked, these preemptive strikes may just gain you the clearance you need.

I’m sure you’re thinking something along those lines. Assume that my insurance company does not cover bariatric or weight-loss surgery, or that it does not cover it any longer. In such case, you’re going to dispute over two things. First, weight-loss surgery should be covered because it is used to treat co-morbidities such as diabetes and hypertension in addition to obesity. Second, this is a request to fix a failed procedure that may result in serious complications in the near future, not for obesity or weight loss. The latter is a more difficult argument to make, but one that has been effectively stated. Remember, just like with your original surgical request, you must document your claims. And, of course, never, ever, ever, ever, ever, ever, ever, ever, ever,

How do you qualify for gastric bypass revision?

Your body mass index, a numerical number of your weight in relation to your height, plays a role in determining your eligibility for bariatric surgery. The BMI range of 18-24.9 is seen as ideal. A BMI of 40 or higher is considered morbid obesity.

If you have a BMI of 35-39 with particular serious health concerns like Type 2 diabetes, sleep apnea, or high blood pressure, you may be a candidate for bariatric surgery. A BMI of 40 or more is also a requirement.

Will insurance cover weight loss surgery twice?

  • Conversion Surgery is a technique that allows you to go from one type of bariatric procedure to another. Lap band to gastric sleeve or gastric sleeve to gastric bypass are the only two treatments that can be converted. Both become permanent after that.
  • Surgery to restore the effectiveness of the original bariatric treatment is known as revisional surgery. Revisional surgery is any operation used to treat failing weight reduction after a gastric bypass or gastric sleeve.

Insurance companies currently consider revisional surgery options to be experimental or investigational. The following are examples of revisional procedures:

Your insurance plan may not cover a second procedure. You’ll need to go over your plan to see what your coverage options are and what standards you’ll need to meet in order to be considered for another weight reduction procedure.

Can you get a revision on gastric bypass surgery?

The bariatric revision operation is only for those who have had gastric bypass surgery rather than a sleeve gastrectomy (often referred to as “the sleeve”) or an adjustable gastric band. Bariatric revision is usually done as an outpatient operation with minimal sedation.

Laparoscopic Revision of Band to Laparoscopic Sleeve Gastrectomy

In a revision band to sleeve gastrectomy, the band and all surrounding scar tissue are removed first. The sleeve gastrectomy is performed after the band, port, and scar tissue have been removed. If a patient has a hiatal hernia, it will be repaired at the same time as the procedure. In most cases, patients can lose 65 percent of their excess body weight, or 65 pounds for every 100 pounds they are overweight. Patients might expect to be out of commission for 1 to 3 weeks. When compared to a simple sleeve gastrectomy, the complication rates are minimal and comparable.

Laparoscopic Revision of Band to Laparoscopic Roux-en-Y Gastric Bypass

According to studies, converting a band to a laparoscopic gastric bypass is the gold standard for a revision band operation. A band to gastric bypass, like other band revisions, is done in a single stage with only one operation. We remove the band, port, and scar tissue first, then proceed with our gastric bypass, similar to a band to sleeve revision. The risks of complications are the same as for a gastric bypass performed on someone who has never had surgery before, as is the recuperation time, which is 1 to 3 weeks. A normal patient can lose 75 percent of their excess body weight, or 75 pounds for every 100 pounds of excess body weight.

Is StomaphyX covered by insurance?

Depending on your surgeon and where you live in the country, the procedure might cost anywhere from $8,000 to $13,000.

Due to the scarcity of research documenting the procedure’s outcomes, insurance companies rarely pay it. There are, however, a number of viable bariatric surgery financing solutions available to help pay for some or all of the procedure.

As previously said, we highly advise against doing this operation until more data confirming its efficacy and safety is available.

How long does a gastric bypass revision take?

How long does bariatric surgery take? True You’s endoscopic gastric revision surgery is done as an outpatient procedure that takes around 30 minutes to complete under minimal anesthesia.

Can I get gastric bypass twice?

Yes, you can have bariatric surgery twice; however, it’s crucial to keep in mind that the risks of complications are substantially higher. While you can have bariatric surgery twice, whether your surgeon recommends a revision depends on a number of factors, including the type of surgery you had, the complications that occurred, your weight, lifestyle behaviors, and whether they believe your personal circumstances are suitable for a second bariatric operation.

What percent of gastric bypass patients gain the weight back?

Early weight loss after bariatric surgery is typically between 47 and 80 percent of extra weight. Weight return, on the other hand, is typically 15–25% of lost weight. This can be quite discouraging for patients, so it’s critical to keep weight expectations in check after surgery.

What is Candy Cane syndrome?

Candy cane syndrome is a rare complication that has been documented in bariatric patients who have undergone Roux-en-Y gastric bypass surgery. It happens when the roux limb is excessively long proximal to the gastrojejunostomy, allowing food particles to lodge and persist in the blind redundant limb. Patients complain of non-specific symptoms such as stomach pain, nausea, and vomiting. Because the disease process is inadequately documented, the majority of people go undetected. Three cases of candy cane syndrome were successfully treated at our facility.

What does revision surgery mean?

Revision surgery is used to improve or amend the results of a previous bariatric surgery. The following are the most common reasons for revision surgery: Complications that arose as a result of the original operation. Failure to shed pounds. Putting on weight after a period of weight loss.