In situations where a bariatric procedure fails, the health insurance company will need to determine what went wrong and why before it will approve any additional surgical procedures to revise it. That can make it a bit more challenging to get approval for bariatric surgery revision. Here are a few things you can expect.
Why the Surgery Failed
One of the first steps most insurance companies will take is understanding what happened with the first surgery. Did it fail, or did the patient not meet their requirements and not comply with the process? If you are looking for a revision for the same procedure, they will want to understand its reasoning and potential benefits.
What Type of Procedure
The insurance company will also want to know what type of procedure is being used the second time, as well as why. This will help the insurance company better understand if there is an opportunity for you to see improvement or if you are likely to struggle with success again. If the prior surgery failed but a new method could be successful, the insurance company is more likely to agree to it.
Proving the Allegations
Some of the most common reasons for insurance to cover a revised bariatric surgery are in instances in which the surgery itself actually failed. For example, you may have a band that slipped or a staple that failed. If the bypass was not working, that could be a factor. However, the insurance company will require verification of what happened. That means they will require CT and MRIs as well as your doctor’s verification of what occurred and why.
Your Health and Condition
Another important factor to communicate with your insurance company is any benefits you have seen from the procedure, such as a reduction in comorbidities. It is important for you and your doctor to show the insurance company that these comorbidities are likely to return if you are unable to have the revision.
There are situations where they will deny the revision procedure. In these situations, work with your doctor to provide the necessary evidence and support the health insurance needs to appeal the current decision. There are nearly always ways and reasons to appeal these decisions, especially if you can demonstrate that your life is on the line as a result of this procedure.
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