Monday, July 14, 2014

Straight from the BCBSNC Guidelines

I'm feeling frustrated, and like there's nothing I can do, so I just feel like copying some sections straight from the Surgery for Morbid Obesity Policy statement for BlueCross BlueShield of North Carolina website.  Basically, I'm going to argue my case with you all, for the hell of it.  I should mention that these guidelines are slated to change this is all going to be somewhat irrelevant.

IV. Revision Bariatric Surgery -
A. Revision surgery to address perioperative or late complications of a bariatric procedure is considered medically necessary. These include, but are not limited to, staple-line failure, obstruction, stricture, erosion, non-absorption resulting in hypoglycemia or malnutrition, weight loss of 20% or more below ideal body weight, and band slippage that cannot be corrected with manipulation or adjustments.
[[HAS]]:  I hope Acid Reflux is a good enough 'late complication of bariatric procedure'.  My EGD on May 5 shows signs of reflux and I was admitted to the ER for a stomach spasm from reflux yesterday.  This could continue to happen if I don't have the revision.

B. Revision of a primary bariatric procedure that has failed due to dilation of the gastric pouch or dilation proximal to an adjustable gastric band (documented by upper gastrointestinal examination or endoscopy) is considered medically necessary if the initial procedure was successful in inducing weight loss prior to dilation, and the patient has been compliant with a prescribed nutrition and exercise program.
[[HAS]]:  I swear BCBSNC, I've been so freaking compliant.  I've tracked my food.  I've joined and actually WENT to gyms.  I've lost between 100-110 pounds depending on the day.  I'm doing everything I can, but I just had far too much to lose starting out to get to where I want to be now.  I'm currently requiring a Lap Band adjustment every two weeks in order to continue losing!

Patients with a BMI greater than or equal to 50 kg/m2 need a bariatric procedure to achieve greater weight loss. Thus, use of adjustable gastric banding, which results in less weight loss, should be most useful as one of the procedures used for patients with BMI less than 50 kg/m2.

[[HAS]]:  In conclusion, I should have never had Lap Band surgery by your guidelines.  My BMI was 50.8 at the time of surgery.  Please please please correct your error.

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