Gotta win 4me

Tuesday, I went to see the weight loss surgeon at the surgery office who placed my lapband in 2010. I went to discuss removing the band and revising to a sleeve or RNY. Well, he does the procedures in two different surgeries, with the weight loss surgery being 3 months later. They submitted the paperwork for the removal and I was approved for that today without evidence. My issue is I don’t want to wait 3 months and have to go through with another surgery. Will I be able to switch doctors and keep the approval for the band removal? I know I have to get approved for the WLS as well. Another surgery center excepted me as a patient today and will do the removal and revision in one surgery. I have Cigna and the changes in their BariatricPal medical bulletin does not have me jumping through hoops so I know that I will have approval as soon as I complete the NUT Eval.

That’s horrible. I cannot imagine. My lapband has a leak and now ALL the weight I lost, I have successfully gained it back. I wish you the best. I am hoping to get mine the second week in October. Fingers crossed!

I agree. He said that the esophagus does not operate correctly when people have had a band in for so long. He also said that there is no way he will waver from that decision with any of his patients. It works out well because my husband didn’t want me to allow him to do my surgery anyway. I told him that there was a leak and he just wrote in my medical records that I was just not eating right so I got a second opinion and confirmed the leak. I’m going to go with the doctor that accepted me.

I spoke with my insurance (Cigna) this morning and they said that all the new surgeon has to do is call and say that I have already been approved for the removal and have them switch it to their (new surgeon) name. So, all they have to do is submit for the revision surgery.

This is GREAT to hear! I just got my Cigna back and I was going to call the surgeon on Tuesday to start the process. It’s good to know that, all I need is a letter from my pcp. Congratulations on your approval.

Hey everyone, I will be starting a new job the 1st week of June and at the beginning of July, I will be able to sign up with Aetna insurance through my new job. I was given information that Bariatric surgery is covered under the plan and that there are 3 consecutive months that I will have to be on a physician-supervised plan. This week I went to see my PCP so that she could start me on a plan, thinking that the insurance company will take the documentation when the surgical center submits the paperwork. Also, I made an appointment with the surgical center but they cant get me in until the end of next month. ***So,that's why I opted to start the plan with my pcp. Am I moving to fast? Will I still have to go more than 3 consecutive months being that I do have the insurance yet (Will my 3 consecutive months start when I start on the insurance plan, only?)? Is it ok, to move ahead with the nutritional plan? Must I wait until I have the insurance? Any advice is needed. Thanks!

Thanks. I think it is 6 months if I’m just going to a pcp and 3 months if I go through the surgeon. I may have to just wait until the end of next month for my doctors appointment. I will call them Monday to get a definitive answer.

I’ve been approved for the mini bypass surgery with a doctor in Mexico. I moved mid last year to a new city so I had to find all new doctors. I have spoken with my primary care doctor and my current metabolic doctor and neither will take on my aftercare. My pcp said she is not familiar and puts me off on the metabolic doctor. The metabolic doctor doesn’t want anything to do with the mini gastric bypass for many reason beyond my understanding. For one he doesnt recommend the mini. He just simply refused and referred me back to my pcp. So, I took it upon myself to try to find someone that my insurance will pay for and no doctor will take me on. Either they say no or they will not return my phone calls. I wanted the gastric bypass but the doctor suggests the mini. My old doctors will take me on but I can’t drive 400 miles both ways if there are problems that I need to see them for. I need a doctor closer. I don’t know what else to do. I don’t want to pay money and I will not have any care afterwards. My insurance covers bariatric but there is a year wait before approval will happen. So, I am choosing to pay out of pocket...I just don’t want to not have care. Any suggestions?

Im really hoping that removing my lapband will not be a problem. When switching to gastric bypass. I really want to get this surgery and I don’t want to waste money if it is not going to be completed.

I think I may go in April for the surgery. I will be going for the gastric bypass whenever I go.

"Within 12 months prior to surgery, a thorough nutritional evaluation by a physician, registered dietician, or other licensed professional experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time." I copied and pasted this from my policy and I did a search of 12 months and 12 consecutive months in the PDF. It does not mention12 consecutive months anywhere in the policy for bariatric surgery. I would like to know, in your opinion, how does this read to you. Call me crazy but that does not say that it has to be consecutive. Maybe a few visits but not consecutive. What are your thoughts? What is this saying in your opinion? I just don't know. if it were consecutive, I feel they would use the word consecutive.

I know this is fairly old but I'm hoping for a reply. I have the Lapland and I would like to get a revision because it is not keep saline....I believe it leaking because every time I go back in for a fill, I always leave with 5cc. How was the process for approval? Did you have to do the 12 months documentation? Thanks in advance for your reply!

I have a question and I'm hoping to get some help on this. I have BCBSNC and I was looking into doing a revision from the Lapband to Gastric Sleeve. My Lapband is leaking fluid...I think. I haven't confirmed it but I have gotten 3 fills in the last 6 months and it is always at 5cc after the fill. So, that was my conclusion. I would like to know if the requirements for the surgery are the same since it is a revision? The requirements for bariatric with BCBSNC is 12 months (Long time). BTW I have gained so much weights its crazy. The band was working fine and it just stopped. Any input is greatly appreciated.

I have not had a fill since December 2015. Since then I have gained 30lbs. Do you all think something may be wrong. I have been researching cause and the slipped band scare me. I don't have any of the symptoms of a slipped band. Plus I don't want to feel like a failure for allowing my band to slip. Is it normal to gain so much weight just because I haven't gotten a fill. I will make an appointment on Monday to resolve my fears but I would like some input.

I think I'm feeling the same way. I don't know if my band has slipped or not. I don't have any symptoms. My chicken gets stuck if it's too dry but other than that I don't have issues. I've gained 30+lbs since July and I'm not happy about it. I finally got below 199 and I stop going for fills. I'm just hoping that I don't have an asymtopmatic slipped band. However, I will contact my doctor Monday morning to set an appointment.

I got my surgery Nov 9 2010. I have lost about 58 lbs. I've only had a fill and a complete unfilI got an infill because unfortunately I developed Gastroparesis---stomach paralysis....from the surgery. I am enjoying the weight loss but not the slow stomach emptying disorder. It's good to see everys progress and non progress. I won't knock the surgery but my only regret for getting the surgery is the stomach disorder I have to endure for the rest of my life. If I had a choice to do it again....I'm torn inbetwern the two!

I was just diagnosed with GP on last week. They did a stomach emptying test and determained this. I had my surgery on November 9, 2010. I ended up in the hospital because the food was not leaving my stomach, and I was in alot of pain. I notice alot of gurgling in my stomach and I really haven't experienced nasuea or pain since the first episode. Just the really bad reflux with the nasty taste of sourness!!! Eww. My GI doctor says that it is the band and my surgeon seems to think it will go away. It has been hard as I don't have children yet and a whole list of I got to take meds everyday. Well I decided the past weekend that body will have to find another way to digest the content because I will not get addicted to drugs. I'm just going to lean on God and pray for healing!! I can eat just about anything...I just wont because I don't know what digest and what doesn't. I asked my gastro doc how bad is it and he told me to talk to my surgeon. WTH!!! I don't get that at all! I have more good days than bad days I just hope my surgeon is right and that this ish will pass! I really need someone to talk to about this so if there is not problem could you please give me a call. I will message my number.

I got banded this mornign and I tell you I prayed for little to no pain and that is just what I got...The only incision that hurts is the port site. The gas is also hurting and it is in my chest, back and shoulders. It hurts worse that the port site. I'm excited to finall be banded! Kudos to my Surgeon Dr. Albert Spaw, Nashville, TN!!! I woke up and I guess the pain meds tthey gave me made me sleepier. It was so hard for me to get out the hospital bed but I finally did!! I was so sleepy I could barely walk! I woke about two hours ago and I feel alright!!:thumbup:

Im having my surgery on Nov. 9th. Im nervous, scared, and excited at the same time! I hace to be @ the hospital @ 630 in the morning! whew I cant believe it! How r u feeling?

Its good to read about ppl that are going through the same situation as I am....Its also good to read about ppl that have gotten the surgery and the ones that have gotten the surgery and talking about it the same day!! My surgery date is on November the 9th and I have to be at the hospital at 6:30a.m.....I'm excited about it and I'm scared and nervous at the same time!! I spoke with my surgeon today and and he told me that he wass going to take care of me...he has been in Laproscpic for 15 years...I have to trust his and I do trust him!! I'm ready to get it over with so I can begin to discover the new me!!!:frown:

I will be having my surgery on November 9th. Im excited about it but of couse I have some anxiety! I've never had surgery before and like all surgery its a risk! I'm pretty healthy just overweight! No comorbities except for acid reflux! Can you guys share with me anything to help calm my thought? Thanks in advance....5 more days and I will be banded!

Hey everybody, I'm new to this site although I have been posting a little for the past week or so! I am getting so close to my surgery date...8 days away!!! I don't know what to expect the day of the surgery and i want to walk out alive. I've never had any surgery and I'm about to freak out!!!:thumbup: I'm excited about this journey and I'm sure that I am going to do well with the LapBand. Please share you surgery day experiences with me!!! Thanks in advance!!!

Let me share my story......On October 22, I was called by the Insurance specialist, at the Surgeons office that faxed all my paper work to BCBS of TN....she called to tell me that I had been approved for the surgery...I was all excited! She made an appt. for me to come in to see the surgeon and set my sugery date on the following Wed. October 27. On the same morning before I went to see the surgeon I checked the BCBS website to check the status of my Pre-Auth and it states that it is "Disallowed":scared2: and that was submitted on the 24th of October. I asked the IS if she was sure I was approved because of the online site and she was adament about the nurse over my case saying that I was APPROVED:thumbup:. She even gave me a copy of the reference# and the nurses number where she took notes when she spoke with her....the nurse also wants her to call her back wiith my dates of service. Apparently on the 25th of October a letter was written and sent in the mail to my address in reference to the surgery...it reads as follows::wink2: "Dear Member, The Purpose of This Letter Recently, BlueCross BlueShield of Tennessee recieved a request from your provider asking us to determain whether your health benefit plan would cover the following procedure: Laparoscopic Adjustable Gastric Band Surgery. Based on the information that your provider submitted, these services are determained to be Medically Necessary. However, it's important to keep in mind that the dertermination that a procedure is Medically Necessary is not a final comfirmation of coverage or benefits. Payment of benefits depends on terms, limits, conditions, and exclusions of your health benefit plan, as well as your eligibility at the time you recieve services. This decision is valid only if all the medical information we recieved is accurate and complete, and is effective until the end of your current benefit period, not to exceed one year." I know I could easily know what going on if I call them but I don't want to hear any bad news on purpose. The insurance specialist at the surgeons off is suppose to call BCBS with my dates of service before services are rendered. I apologize for the lengthy message but they could have just used the words APPROVED or DENIED!!! It is covered based on my insurance plan so I don't know what to make of this....I guess ima wait until the IS call me back after reporting my DOS to the Nurse over my case. Insurance lingo.>>>> We will see! What do you all think???

Thanks for the assurance...I wish they would just use the words Approved or Denied!! It would make things so much easier. After I posted the reply. I did give BCBS a call because I know me and a person word other than someone at BCBS is not going to fly with me!! They said that it is approved so I'm extra excited not!!! I'm ready for this to start!!!! Thank again for your help!!!:thumbup:

I went for Pre-Admittance to day and got all my test done. I went by the metabolic center and let her read the letter and she said that it is indeed an approval letter. She said that my insurance company does not pre authorize out patient procedure. They only pre determain if it is medically necessary. Thanks for all your help!!!