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Thinking of having another weight loss procedure?

A second weight loss procedure may or may not be covered by your insurance plan.  Please review your plan for your coverage information and the requirements that are necessary in order to be considered for a second weight loss procedure.

Definitions:

Conversion Surgery – Surgery to change from one type of bariatric procedure to a different procedure.

Revisional Surgery – Surgery to restore the effectivness of the original bariatric procedure.

Conversion and revisional options:

There are only two procedures that can convert to a different weight loss procedure:

  • Lap Band to either a gastric sleeve or gastric bypass
  • or
  • A gastric sleeve to a gastric bypass
  • Any procedure to treat failed weight loss for the gastric bypass or gastric sleeve are considered revisional surgery.  Bypass or sleeve revisional surgery options are currently considered investigational or experimental by insurance providers.  Some types of revisional procedures are but are not limited to:
    • Stoma Plication
    • Stomaphyx
    • Rose Procedure

Indications of failed Weight Loss Surgery

  • Medical and or Surgical complications or malfunction of the LapBand / Gastric Sleeve
    • Slippage of the band
    • Erosion in the area of the band
    • Port related complications
    • Esophageal dilation
    • Dilation of gastric pouch (sleeve)
    • Dilated gastrojejunal stoma (sleeve)
    • Dilation of gastrojejunostomy anastomosis (sleeve)

Program Requirements

You must have the ability to demonstrate compliance with the previously prescribed postoperative nutrition and exercise program through documentation by either your primary care physician or surgeon for at least two years after the primary surgery. This information would include, office visits with the surgeon, nutritionist or behaviorist, attending support groups and keeping a journal of your weight loss journey.

  • At least two years has elapsed since the primary bariatric procedure.
  • You have not had adequate weight loss from primary procedure.
  • Sleeve – If the primary procedure was successful in inducing weight loss prior to dilation of the pouch or GJ anastomosis.
  • Band – If the complications associated with the band cannot be corrected by manuipulation, replacements and or adjustments.
  • You must have been compliant with a nutrition and exercise program after the primary procedure.
  • Your BMI is at least 35 or greater and you still have co-morbid conditions.
  • You will be required to complete the same program for Weight Loss Surgery including any insurance requirements for 3 or 6 month documented supervised visits, HNE, Cigna, ConnectiCare, and or Aetna.
  • KEY NOTE: All insurance providers requires a medical reason for requesting another weight loss procedure. Some insurance providers are more specific than others in terms of what they will accept as a reason for not being successful with the primary weight loss surgery.
  • A second weight loss procedure requires prior authorization from your insurance provider.

 What do I do next?

  1. Schedule an office visit with your physician.
    1. At the first appointment you will discuss the reason why your current weight loss surgery is not the best option for you. Your physician may need to schedule appropriate test.
  2. At the end of this visit you will receive two copies of the Emmi education log in information for both the sleeve gastrectomy and the bypass weight loss procedure.
    1. It is important for you to review both Emmi educational programs before your next appointment.
    2. Schedule a second office visit.
  3. At the next office visit you will discuss the outcome of any test that may have been performed and if you are a candidate for a second weight loss operation. At this time you would let us know if you would like to move forward with a second weight loss operation.

 When will I have my band removed?

Your band will be removed before you are scheduled for your second procedure.  Literature show a reduced post operative complication rate if the band and port removal are performed separate from the second weight loss procedure.

  1. You can decide when to remove the band unless it is an emergent situation.
  2. Removal of the band requires prior authorization from your insurance company.
  3. Option One: Have it removed while you are completing the program for your second procedure. NOTE: if you choose this option you will accept the risk that you may not be approved for the second procedure and replacing the band will not be an option.
  4. Option Two: Wait until the end of the program requirements are completed and submit all the paper work for prior approval and wait to see if the second procedure is approved. Then we will submit notes to the insurance for the band removal prior approval.
  5. You will have to wait six weeks from the date of your band removal before your second procedure can be scheduled, as long as there are no complications from the operation.

 

 

 

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