Fighting Insurers Who Deny Anti-Reflux Surgery After Sleeve Gastrectomy

 

This is a story we are seeing all-too-often in our work overturning bariatric surgery denials. . . see if it sounds familiar.  If it does, you need to contact us ASAP because WE CAN HELP!

It goes something like this: 

You’ve suffered from extreme obesity most of your adult life.  You tried both medically-supervised and self-directed weight loss plans but never succeeded achieving permanent weight loss.  Maybe you started suffering from comorbidities like sleep apnea or type 2 diabetes or hypertension and ultimately it was clear bariatric surgery was medically necessary.  You consult with your bariatric surgeon and undergo a vertical sleeve gastrectomy (VSG), which is now the most commonly performed weight loss surgery performed in the U.S.

At first, you are thrilled with your results.  You FINALLY see meaningful weight loss that “dieting” never delivered.  More importantly, your co-morbidities are resolved.  Think of it!  No more CPAP or you’ve been told you can stop some of your medications.  You are HAPPY!

But time passes – maybe even several years – and you start suffering from symptoms of severe GERD which is a known complication of the sleeve gastrectomy procedure – it can happen even if you never had it as a co-morbidity prior to your VSG.  GERD isn’t just occasional “heartburn.”  It can be life-threatening by substantially increasing the risk of developing severe esophagitus, Barrett’s Esophagus, dysplasia and esophageal cancers. It may cause additional symptoms such as asthma, coughing, chronic hoarseness and significantly diminished quality of life.  GERD is a SERIOUS DISEASE!  

We have overturned denials of anti-reflux surgery after sleeve gastrectomy when payers have tried all sorts of bogus reasons to not pay for the conversion to a gastric bypass including things like:

  • “This procedure is experimental, investigational or unproven…”
  • “Conversion is not medically necessary because the member does not meet our medical policy criteria for a revision…”
  • “Only one bariatric procedure per lifetime is covered…”
  • “Member is no longer morbidly obese so a gastric bypass is not medically necessary or medically appropriate…”

If your insurance company (or your patient’s insurer if you are a provider) is forcing you to live with intractable GERD following your sleeve gastrectomy, we are able to help and urge you to CALL US TOLL FREE at 877-992-7732 to discuss your options. You don’t have to live with terrible acid reflux just because your insurer says so!

601-C East Palomar Street #480 Chula Vista, California 91911 Tel - 877-992-7732 Fax - 844-384-9199

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