FXDF2008

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.

Spoke with the M.A. at my surgeon's office this afternoon. Asked the following questions and received the following answers. If anyone can suggest other questions I should ask when I meet my surgeon, I would appreciate it very much. 1. From your experience, are removals and revisions generally covered by employer insurance even if the original surgery was either self-pay or covered by another insurer? A. Removals are usually covered as they are considered a complication and medically necessary. Revisions depend on the coverage. 2. If they do cover the revision, do they typically require the mandatory six month weight loss program requirement? A. Insurance requirements are rapidly changing - hard to say at this time. 3. Pending the results of the endoscopy, would it be harmful to wait until my new benefits take effect at the beginning of the year before removing the band? A. Depends on the results of the endoscopy 4. Could the removal and revision be done at the same time? A. No. You need time to heal from the removal 5. How many removals and revisions has my surgeon done? A. Quite a few (no numbers provided, will ask surgeon directly) 6. Generally, how long is the recovery for the removal and for the revision to the sleeve? A. Removal of the band, about the same length of time when having the original surgery. Revision depends on the patient. 7. Is the removal procedure inpatient or outpatient? A. Usually outpatient 8. Typically, how long is the hospital stay for the revision. A. Overnight 9. Is there a stomach tube with the revision? How long does it stay in? A. Sometimes. Depends on the patient. She informed me that she will contact my PCP in the morning to make sure they have all the information they require in order to make the referral for my endoscopy. They want that done ASAP. She also suggested that I speak with a rep from BCBS during open enrollment to discuss my specific situation and what actions I need to take to assist in getting approved for the revision. I know that everyone's situation is unique and everything I asked here may not apply to your situation, but I hope that my experience can help others in similar situations.

Hi CowgirlJane, I know that BCBS AL does cover the sleeve. I just don't know if they cover revision after band failure especially if the original procedure was either self-pay or covered by another insurer. This remains to be seen. I am currently waiting for a call back from my bariatric surgeon and have a boatload of questions written down so hopefully things will be somewhat clearer this afternoon.

I have had my band since February 2007. Yesterday, I went in for an upper GI to check and make sure my pouch hadn't stretched. I haven't had any pain or discomfort, no vomiting, or acid reflux. My only complaint was that despite having an almost full band, I could at times eat much more than I thought I should be able to. Hence the decision by my doctor to do the upper GI. As reference, I began at 277 before my lapband surgery. I got down as low as 183, bounced back up to 223 and am now sitting at 211 with a BMI of 32. My goal weight is about 165. This is in a period of almost four years. When I drank the contrast liquid, we watched as the Fluid went down the esophagus, into the pouch, and through the stoma. We also watched as some of the liquid went AROUND my band! The only way that can happen is if a portion of the band is now INSIDE of my stomach. Preliminary diagnosis is band erosion. Next week I will be scheduling an endoscopy to determine the extent of the erosion and see how much damage has been done to my stomach. In the brief conversation I had with my doctor after the discovery, he stated that the only option for treatment is removal of the band. You could have knocked me over with a feather. I have become dependent on my band and to think of not having restriction is a scary thought for me. Like others, the thought of going back to the weight I was at before is not an option. My doctor has indicated that once the band has been removed and I have healed from that surgery (after about four months), I can either be re-banded (I don't think so), or I can do a revision to either bypass or gastric sleeve. I am not keen on the idea of bypass. It just seems so extreme and there's no where to go after that surgery. So I am leaning towards the sleeve. From everything I have read, the majority of people who have had this procedure are very happy with it. Yesterday was spent trying to wrap my head around the prospect of having two surgeries next year. Talking with my family and trying to understand my options. I am fortunate in that my situation is not an emergency. There is no infection and I can eat properly. (The doctor did deflate my band completely). I also have insurance through my company and the enrollment period is coming up in the next couple of weeks so I can make decisions accordingly knowing that I am going to have these surgeries. It is still yet to be determined if my insurance company (BCBS AL) will cover either surgery (scary thought), but I'm willing to fight for it. I was self pay for my band so I don't know if that will impact their decision or not. I know they do cover WLS and have the typical six month waiting period (not sure I would have to do that given the circumstances). I will be posting here with my progress and experience for the benefit of others who may encounter similar complications and decisions. I would very much like to hear from others who have had band erosion and have done the revision to the sleeve or those who have the sleeve and what their experience has been with that type of surgery. I can't believe I'm at this point again. Ugh.