FXDF2008

Hi Pookeyism, My new surgeon suggested that I go directly to the hospital for the operative report and I have done that. Hopefully that's all that he'll need. He is going to be redoing the upper GI, upper endoscopy and also doing an esophageal manometry in three months so the other information will be outdated by then. I have pictures of the original band placement as well as the images and report from the endscopy showing the erosion so he was good with that. I am just annoyed that I asked three times for my records and received no response after being told that if I needed anything to please contact them and wishing me the best. Their actions speak louder than words.

I just had a consult today with a new surgeon in regard to a revision from band to sleeve. I had my eroded band removed three months ago. He told me today that he waits six months after removal in order for the site to completely heal and the scar tissue to form. In three months, I will have an upper GI (to see how much restriction I have), an upper endoscopy (to look at the scar tissue) and a procedure I had never heard of called an Esophageal Motility Study using manometry. This test measures the function of the esophagus to make sure it is working properly. Due to the removal of the band and subsequent scar tissue, it can affect the ability of the esophagus to keep food from coming back up especially with the high pressure that the sleeve creates. This makes complete and total sense to me and I'm sort of surprised my prior surgeon didn't recommend it. I definitely don't want to have to live the rest of my life with acid reflux. He said that scar tissue probably wouldn't keep me from having the surgery, but the function of my esophagus definitely would. Just something new that I learned today that I thought I would pass along.

So BCBS-AL did not require you to do a six month weight loss program or meet the BMI or co-morbidity requirements? Was your original procedure covered by insurance?

This is a letter I wrote to the practice administrator for Dr. Cywes and Dr. Pinnar outlining the many reasons I decided to go with another surgeon even though it will cost me more money and time. I wasn't going to post it publicly, but since they seem inclined to ignore my repeated requests for my medical records, I feel justified in doing so. For what it's worth I do like Dr. Pinnar, but the accumulation of all the issues below finally motivated me to make the change. Dear ******, I am contacting you as the practice administrator to request that all claims submitted to my insurance provider be withdrawn and to outline the reasons for my decision to go with another practice for my surgery. I will apologize in advance as this may be rather lengthy but this has been a difficult decision and one that I have weighed for the past month. On February 7, 2008 I had lap band surgery which was performed by Dr. Cywes. I had considerable success until approximately two years ago when I began to be able to eat more and began to put on more weight. I then went to Dr. Baptista for maintenance fills primarily due to my past experiences of having to wait hours to get in for a fill with Dr. Cywes. It was faster and easier for me to get them done by Dr. Baptista. Last November, Dr. Baptista order an upper GI to check my band and discovered that my band had eroded. This was confirmed by an upper endoscopy in December. It was at this time that I decided I wanted the gastric sleeve but I was not comfortable with Dr. Baptista’s level of experience in this area so I made a call to Dr. Cywes as I felt more comfortable with him with a more complicated surgery. When I called and explained my situation to the person who answered the phone, she placed me on hold and then came back and informed me that Dr. Cywes felt I should have Dr. Baptista perform the surgery. In other words, he was not interested in seeing me since I went to his former partner. At this point, I decided to go to Dr. Webb’s practice to explore this option. When Dr. Webb’s office requested my records from your practice, I subsequently received a call from the office inquiring as to my reasons for pursuing another surgeon. I explained my experience to her and she assured me that Dr. Cywes did not mean that he was not interested in seeing me and that there were options out there that Dr. Cywes would like to speak with me about. She suggested that I come in with no obligation other than to hear what options were available to me and I agreed. After meeting with Dr. Cywes, I agreed to have him do the surgery to remove the band and subsequent repeat surgery. This was on 2/1/2012. It took a month to submit the initial pre-determination request and the subsequent appeal letter as a result of the initial denial by my insurance provider. We received the approval to proceed on 3/1/2012. Due to an issue at Shand’s with Dr. Cywes, I had to schedule the surgery for 3/29/2012 with Dr. Pinnar at Memorial. Everything went smoothly. I liked Dr. Pinnar immediately and felt comfortable with him. On April 6th, I had my post-op follow up appointment with Dr. Cywes in order to remove the abdominal drain that Dr. Pinnar had placed during my surgery. On April 27th (3 weeks later) I had another post-op appointment. In those three weeks I had put on weight due to my lack of restriction and not following the low-carb plan. As is typical for Dr. Cywes, he saw that I had gained weight and he gave me his usual talk about our relationship with food for 15 minutes and when he was done he said that he would need to tighten my band. I then had to inform him that I didn’t have a band. It appears that he hadn’t even looked at my chart prior to coming in. He just assumed that I had been not following the program. When I got back to my office, I wrote ***** and asked that my gastric sleeve surgery be performed by Dr. Pinnar. I am not comfortable having such an invasive and complicated surgery performed by a surgeon who doesn’t bother to read my chart in his office. On May 15th, after repeated attempts to contact ***** to inquire as to the status of filing a claim for surgery with my insurance company, I finally wrote a lengthy email expressing my frustration with the practice, lack of communication and lack of action in filing my claim. I copied you on this email and it is attached. At this point I finally received a response from ***** saying that she was having computer issues and had not been receiving emails. I responded to her expressing that I understood about computer issues and asked when she would file my claim. She wrote me back on May 17th and said she would be filing it that day. The next day (May 18th) **** wrote to me explaining that she had faxed clinical information to my insurance company. She stated that my current BMI was 35.8 and that if I had a BMI under 40 I would require a serious co-morbid condition to get approved for the sleeve. I wrote back to her explaining that since this surgery was a result of an eroded band that I didn’t believe my insurance would require me to have a co-morbidity. I didn’t hear back from ***** until May 25th stating that she had finally filed my claim. On June 1st, I had a follow-up appointment with Dr. Pinnar. Once again, I had gained more weight, but I wasn’t concerned about it as I knew the reasons why. While I was waiting for Dr. Pinnar, the nutritionist came in looking very concerned and asking me what was up? She also asked me if I felt I had sufficient restriction. I explained to her that I didn’t have a band. She then asked if I was a conventional weight loss patient. This was not the first time she had seen me but once again, it was a case of not reviewing a patient’s information before coming into speak with them. I also had a chance to speak with **** and express some of my frustrations and concerns about the filing of my claim. She assured me that she understood and that she would make sure my claim was filed properly (i.e. for a repeat surgery as opposed to a first time surgery). After **** left, I proceeded to wait approximately 45 minutes to see Dr. Pinnar. He knew I was there as I spoke to him when I first came in. I could hear him out in the hallway talking on the phone and waited patiently for him to finish his conversation. I justified that it must be an emergency since he knew I was there and was keeping me waiting. When he finally came in, he apologized and explained that he was on the phone with his attorney. I was aware of the issues he was having with the physician who bought his practice in Virginia and we discussed that matter for a few minutes. Thankfully, he was aware that I had had my band removed due to erosion. Still, I am a very busy woman. I manage the cash for ********** in their Treasury department. My boss depends on me a great deal. I understand that Dr. Pinnar has some serious issues going on, but he needs to address them on his time, not mine. On June 7th, I wrote to ***** to advise her that my insurance company had submitted a reply to their correspondence department stating that in order to approve the surgery for the sleeve I would have to complete a six month weight loss program with my PCP, which is standard for someone having their first bariatric surgery. Since this is a repeat surgery resulting from erosion, I feel that this requirement should be waived. In my email, I reminded her of this and asked her what the next steps would be for my appeal. I wrote again on June 12th and again on June 14th asking what the next steps in the process would be. To date, I have not had a response from her. ****, I hope you can understand my frustration with this process. I am frankly tired of being ignored and having to constantly remind my health care provider of my medical status and hand feed insurance policy language to support my claims. I have registered with another practice and have an initial consult this Friday with them. I would appreciate my records being sent to them as promptly as possible once they submit the request for them. Even though this is going to cost me a considerable sum of money and probably a little more time since I am basically starting over again, I feel I will be more comfortable with a practice who respects my time and communicates with me. I am a very patient person, but my patience has been pushed to the limit.

Congrats on your approval! May I ask why you are having to have your band removed? I had mine removed due to erosion and the surgery coordinator is currently (supposedly) in the process of submitting the paperwork for my sleeve surgery. I also have BCBS (AL) so I was wondering what they were going to require of you to get the revision done.

I also have BCBS-AL and had my band removed due erosion on March 29th. Had my band placed 2/7/2008. Waiting now for my surgeon's office to file the claim for revision to sleeve. I haven't been real happy with them as of late and if I don't hear that they have filed my paperwork by the end of next week I am considering switching surgeons. Not happy with having to tell them how to do their jobs and the fact that the head surgeon suggested filling my band at my last post op appointment because I had gained weight. (He had removed my stomach tube from my surgery three weeks prior).

Had my lap band removed on Thursday, March 29th. My procedure seems to have gone pretty smoothly. I wasn't nervous at all. Didn't have any nausea. My surgeon said that everything looked the way he anticipated it would look. He placed a drain in my stomach which was a bit of a surprise. I wasn't expecting that. He said it was a last minute decision on his part. Now I have to figure out how to deal with that while at work. They took me down on Friday morning for my leak tests. They said everything looked fine but it took until 7:00 for my surgeon to let me know it was okay for me to drink. Then I had to drink a certain amount within a couple of hours before he would let me go home. I drank what I was supposed to, was discharged around 11:00, then we had to run around getting perscriptions filled. I was really tired by the time I got home. My only real complaint is the dry mouth I get while I'm sleeping. I don't have a lot of pain, just soreness. Oh, I gained 10 lbs in the hospital!!!!!! It's beginning to go down slowly but they really kept me hydrated! LOL So basically, the band removal seems to have been a lot easier than having it placed. Now I need to work towards getting my sleeve. My surgeon has said that if I had another band placed that I would more than likely erode again and I certain don't want to have to do this again. Onward and upward!

Well after many months and many ups and downs I finally have a date to have my eroded lap band removed. March 29th is the big day!!!!!!!!!!! I will have my surgery VERY early in the morning and will stay overnight to make sure there is no leaking from the repaired area of my stomach. Hopefully, if all goes well, in two months I will revise to either the sleeve or banded plication. There is much to consider with both of these procedures and the positives and negatives are pretty well balanced. I have read good and bad things about both procedures. Right now though, I'm just going to focus on getting the band removed and see what kind of damage it's done. So far I have felt no effects other than an occasional pull or tug or momentary pain in the area just below my sternum. I still have some minimal restriction due to there being a plastic ring in the middle of my stomach but I can pretty much eat anything I want and have been. I figure that eventually I will have the tool necessary for me to succeed so I might as well enjoy myself while I can even though the weight gain is making me feel miserable physically. I can't wait to be thin again. Weird how the mind justifies things. If I couldn't eat another cheeseburger tomorrow it wouldn't bother me, but since I can I do! Ugh. I'm definitely ready to get back on track. Let's get this party started!

I went to the surgeon who originally placed my lap band today to talk about the surgery I need to have to remove it due to erosion and subsequent revision surgery. I had my head completely reconciled with having vertical sleeve revision and then he threw in a new option. For the past year, he has been doing banded plication surgery. In my particular situation, due to the erosion, we would do the surgery to remove my band first, give my stomach time to heal, and then I would have a second surgery to revise to the banded plication. For those of you who are not familiar with this procedure, it involves folding the stomach in on itself and stitching it to achieve a sleeve like effect. This is a similar procedure to the old stomach stapling procedure but much more effective due to technique and the usage of sutures as opposed to staples. Then, he will place another band at the top of the sleeve thereby essential having two weight loss surgeries at one time. My understanding is that the plication is better for achieving immediate weight loss, the band is better for long term weight loss. Combining them is essentially the best of both worlds with a few added benefits. First, because you have restriction from the plication, you don't have to fill the band as fast or as much in order to achieve satisfactory restriction. Second, because of the more slender shape of the stomach, incidences of slippage are greatly reduced. Third, there is no need to dissect 90% of your stomach. Fourth, if you do have a problem with the band, it can be removed and you will still have restriction from the plication. As always, there can be complications. Sutures can come undone. There can be necrosis of the upper part of the stomach right below the band. My understanding is that so far, the complication rate is extremely minimal and weight loss results have been comparable to the sleeve. I have to admit that the thought of not having to cut my stomach is appealing to me. At the same time, the thought of putting in another band after my first one eroded is a little unnerving. My surgeon is not pressuring me to do either one. He wants me to do what I'm comfortable with but he is very excited about the results he has seen with this surgery. I am 52 and this is more than likely my last chance at getting to be where I want to be. This is still considered to be investigational and is not covered by insurance but I believe the majority of the costs will be covered by research study funds. I have complete confidence in my surgeon. He secondary specialties are liver transplants and pediatric surgery and he is always at the cutting edge (pardon the pun) of the latest and greatest bariatric surgeries. I just want to do the right thing for me. My instinct is to let him get in there and take out my band, take a look around and see what kind of damage my band did to my insides. Then, make a more educated decision about which surgery would be right for me. As an aside, he completely refuses to do gastric bypass. What would you do??

Thanks Christin, I know they're just doing their job, but this is my health we are talking about. Why the he!! am I paying for the most expensive coverage my company offers and having to fight for them to cover something that is wrong with me. I just don't get it. Trust me, I will keep fighting for as long as it takes.

Sorry I had to change the image to take out personal info. New link is below.

Oh and my insurance carrier is BCBS of Alabama but it is self-administered by the company I work for. You ask a good question about if I had been covered by insurance. I believe if it had been approved by another insurance company that there would be no problem. It looks like I will have to convince them that I qualified five years after the fact. I'm willing to fight for this, but they're making me crazy already!

Now that I have figured out how to upload pictures, I will let you decide how bad my erosion is. Now you know why I am on pins and needles trying to get approval. I want this thing out of me before it does even more harm. I know there will be damage, scar tissue and adhesions. That is why my surgeon wants to do it in two phases. You are quite correct that I may not be a candidate to go to Mexico. Time will tell If that doesn't work just go to the members gallery and look for My Erosion - FXDF2008

The first thing my doctor did when we discovered the erosion was to remove all fluid from my band. Needless to say I've been packing on the pounds since then even though I have some restriction due to the fact that I have an obstruction in my stomach. May I ask why your band needed to be removed?

They say that if I did not meet the criteria for medical necessity when I received my lapband that they would consider it to be cosmetic and would not cover any complications from that surgery even if those complications are life threatening. The thing is, if I had insurance, I would have qualified. I had a BMI of 40 and had sleep apnea. I had repeatedly tried to lose weight, twice with weight watchers and one of those times I lost over 100 lbs only to gain it back over again. That is why I opted for weight loss surgery. I felt blessed at the time to be able to afford to pay out of pocket. Now I'm being penalized for that decision. I'm walking around with a fully eroded lap band (the endoscopy shows it right in the middle of my stomach) which, if it becomes infected, could cause significant health issues and they are giving me the run around. Wanna hear the ironic part? I work for a medical supply distributor. Go figure.

I got my lapband almost exactly five years ago. I was self pay so did not need to jump through the insurance hoops to prove that it was medically necessary for me to have it although I could have if I had insurance at the time. I wasn't employed but I had come into some money so I could afford to do it self pay. A wonderful thing so I thought at the time. Now my lapband has eroded and I need to have it removed but my insurance is giving me the run around trying to say that I got it for "cosmetic" reasons. I guess if an insurance company doesn't give their blessing that it is medically necessary then they assume that it wasn't. Anyway, I was just wondering if anyone had experienced this before and what the outcome was. I'm terrified that my insurance company isn't going to cover the removal of my band much less the revision surgery to the gastric sleeve that I want just because I was original self pay. Thanks for any input anyone can provide.

I currently have a very eroded band (in the middle of my stomach) and am waiting on a surgery date to have it removed. I have had absolutely NO symptoms with the exception of weight gain because I have only moderate restriction provided by the obstruction in my stomach. Lately I've been feeling some twinges and odd little feelings and pains but I'm not sure if they are related to my band or just me being hyper-conscious because I know something isn't right. I have to agree with the others though, it sounds a lot like slippage to me. I would try to get in sooner if you can.

First a little background. Got my band almost exactly five years ago. Discovered a couple of months ago that it has since eroded and will need to be removed. I am wanting to do a revision to the sleeve once I have healed from the removal surgery. I have met with the surgeon and they have submitted the paperwork to my insurance for the removal which I fully anticipate will be approved. I downloaded and printed out the entire bariatric policy from the BCBS-AL site. Below is the verbiage specific to my situation: V. Revisions - Effective for dates of service on or after March 15, 2010: Gastric Surgery Adjustable Gastric Restrictive Devices Revision or removal of adjustable gastric restrictive device meets Blue Cross and Blue Shield of Alabama's medical criteria for coverage for the following indications: Band erosion or slippage; OR Infections around the port site Repeat surgery for morbid obesity for other than the stated surgical complications does not meet Blue Cross and Blue Shield of Alabama's criteria for coverage. I am hoping that I am reading the last part correctly in that it seems to state that repeat surgery should be approved as long as it is as a result of erosion, slippage or infection. Does anyone else have experience dealing with this specific insurance and/or issue?

He stated that it would just be a few days for the band removal. We haven't talked about the sleeve surgery in detail as of yet but he seemed to think my recovery from that would be fairly quick as well. From what I've read on various sites, this doesn't seem to be the case. Fortunately, I am able to work from home if I want or need to.

It has been a while since I have written, but it's been because I've been in a holding pattern waiting for my new insurance coverage to kick in. Fortunately, my band hasn't given me any issues besides some minor pulling feelings and twinges. I have had no sign of infection thus far thankfully. While I was waiting for the updated insurance, I gave a great deal of thought about who I wanted to do my surgeries. The doctor I had been going to for my band maintenance is a capable surgeon and a nice enough person, but I wasn't comfortable with his level of expertise in doing band to sleeve revisions. I did some research and found another surgeon here locally who has been doing sleeves for more than four years and has been doing band to sleeve revisions about once a month and is doing them on an increasingly frequent basis. In his words, a band to sleeve revision is not bariatric 101 surgery. It is more complicated due to scar tissues and adhesions from the band. I like his forthright attitude and his confidence, so I am waiting for a call next week to schedule the first surgery to remove the band. We will then wait three to six months and do the revision to the sleeve. He indicated that he will probably keep me overnight in the hospital for the band removal as he uses a stomach tube for drainage and that will need to be removed and he also wants to make sure there are no leaks. However, he also said that in all likelihood I can have the surgery on Friday and be back to work the following Monday as long as I have a sedentary job which I do. I am ready to get this process started. Let's do this thing!

I'm just starting my revision journey due to erosion so haven't been down your path yet. Just wanted to wish you the best of luck in your next appeal. Keep fighting!

Went for my upper endoscopy today. Band erosion confirmed. You can clearly see half the band on the inside of my stomach. Will be meeting with my surgeon soon to come up with a plan of action. Here's hoping my insurance will cover revision to the sleeve.