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Bariatric Surgery/Revision Surgery and Insurance Coverage

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Expert: - 1/24/2009


Question
I had a gastric bypass in 2000. Prior to the surgery I weighed 252 lbs.  I dropped down to 175 but began to regain the weight in the last 2 years.  I am now 220 lbs.  I am interested in revision bypass surgery (I had a RNY) but I am not sure if insurance might cover this procedure.  I was told by the health professional at one center that insurance companies consider bariatric surgery a once in a life time benefit and will not pay for any repeat bariatric surgeries.  Is this true?

Answer
Anne,
Some insurance companies do have a "one per lifetime" policy for bariatric surgical procedures but these are in the minority.  I encourage you to call the insurance company yourself and ask - nothing bad will happen as a result of asking the question.

To my way of thinking, the first thing to decide is whether it might be reasonable to do a revision from a medical and surgical standpoint.  For better or worse, the fact is that most patients who gain weight back after gastric bypass would not benefit from surgical revision.

If you and your surgeon agree that revision surgery is a proper goal, then you can worry about the insurance status.

Best of luck,
Dr JP

Bariatric Surgery

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Volunteer

John Pilcher, MD

Expertise

I can answer medically oriented questions about bariatric surgery including: patient selection, preparation for surgery, differences between types of bariatric surgery, aftercare following bariatric surgery. I can answer detailed questions about gastric bypass, Lap-Band, gastric sleeve, and revision bariatric surgery. I am only somewhat familiar with Biliopancreatic diversion. I am not prepared to answer insurance or other financial questions related to bariatric surgery.

Experience

I have been a practicing bariatric surgeon since 1995. About 85% of my current practice consists of bariatric surgery, including all of the above procedures except biliopancreatic diversion. I am the senior surgeon of a 5-surgeon group. I am recognized among surgeons and other medical professionals as the most experienced bariatric surgeon in my region.

Organizations
Fellow of American College of Surgeons Member, American Society for Bariatric Surgery

Education/Credentials
BA in Biochemistry - University of Virginia Medical Degree - University of Virginia Surgical Residency - University of Virginia

Awards and Honors
Alpha Omega Alpha

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