When does insurance cover revision surgery?

Does Insurance Cover Revision Surgery?

The number of people undergoing weight loss surgery has been on the rise. While some surgeries have been successful, there have been instances when a revision is necessary.  In this case, revision is defined as a change or modification of previous surgery.  The revision can be as a result of a failed bariatric procedure or revision to a new procedure.

When does insurance cover revision surgery?

The question of whether your insurance provider will cover your revision surgery is not an easy one to respond to.  Any request for a revision necessitated by a previous bariatric surgery that failed will cause the insurance provider to question whether the surgery failed or the patient failed to follow all the post-surgical requirements.

Any type of weight loss surgery requires the patient to commit to making lifestyle changes if they want to be successful in achieving their weight loss goals. The patient will need to make changes in their diet and become more aware of the nutrients and calories in the foods they consume. This can be difficult for most patients especially when their psychological needs have not been attended to. The patient could also be struggling financially and is therefore unable to purchase the correct foods.

What Does Insurance Want To Know?

Since the insurance company will want to know why you need a revision, you should be able to answer their questions satisfactorily. Your surgeon must be aware of your need for a revision and any issues related to the original procedure.  This is the information that you should provide to your insurance provider as you request authorization for a revision.

Any claims of a stretched pouch or failed staple line or slipped band, or a bypass that’s not working as it should be proven by undergoing pre-op testing.  You can get an MRI, CT scan, or Endoscopy done so that you can get the results to present to the insurance provider.  In addition, you should provide your surgeon with all the information regarding lifestyle changes made post-surgery as evidence of compliance.

It’s also important that you let your insurer know that the failure to grant you a revision could lead to an increase in your BMI. This increase can lead to a return of obesity-related health conditions such as diabetes, sleep apnea, and hypertension.  Should your request involve a new type of surgery or one that was not available when you had your surgery done, ensure that you include all the required information in your request.

Your insurance provider will only pay for a revision when you provide them with all the relevant information.

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