want2bthin

This is a great idea - I'm 5' 1 1/2" also. I just got my surgery today - scheduled for March 7th. I will have a revision from a band to a sleeve. I start my pre-op diet on Wednesday. I am soooo looking forward to the day when I can shop in the Petites section - although a lot of those Petite size pants are still too long for me - LOL Susie

Thanks for the encouragement. I intend to keep on fighting. I saw my Primary Dr. again this morning and he is going to write a letter for me to send with the second appeal. I'll also get in touch with my surgeon's office next week and press them to drive the appeal this time instead of me. Happy Thanksgiving everyone!

Just heard from United Healthcare that my appeal has been denied for a revision to VSG. They already approved the Lapband removal but not the revision. I don't have the paperwork yet but the coordinator said their response was several pages long but amounted to that they felt I didn't have success with the Lapband so would not have success with another restrictive procedure. I feel there is no comparison to having VSG vs. Lapband and I explained that in my appeal letter (which was 42 pages in total since it included years more of medical records). I'm told my next step is to submit for a Level 2 appeal which will be reviewed by my employer (a major corporation). I'll post this on the Insurance forum too but am just hoping for some encouragement and advice from others who may have been through the same thing. Thanks. Susie

Thanks for the encouragement. I intend to keep on fighting. I saw my Primary Dr. again this morning and he is going to write a letter for me to send with the second appeal. I'll also get in touch with my surgeon's office next week and press them to drive the appeal this time instead of me. Happy Thanksgiving everyone!

Just heard from United Healthcare that my appeal has been denied for a revision to VSG. They already approved the Lapband removal but not the revision. I don't have the paperwork yet but the coordinator said their response was several pages long but amounted to that they felt I didn't have success with the Lapband so would not have success with another restrictive procedure. I feel there is no comparison to having VSG vs. Lapband and I explained that in my appeal letter (which was 42 pages in total since it included years more of medical records). I'm told my next step is to submit for a Level 2 appeal which will be reviewed by my employer (a major corporation). I've posted this on the band revision forum too but am just hoping for some encouragement and advice from others who may have been through the same thing. Thanks. Susie

I was denied by UHC PPO - I am a band to sleeve revision. I was approved for my Lapband to be removed but not for the sleeve since they said I didn't have the 6 months pre-op supervised diet. That is such a crock because living with a Band for 5+ years restricted my calories and I went through the whole process way back then for WLS. In any case, I just sent in my Appeal Letter on Tuesday and should hear in a couple of weeks so I appreciate prayers and positive thoughts from those who have gone through this before. Just wondering if those of you with UHC were denied through Optum Health - seems they use them for their Medical Reviews. The people there were nice and understanding on the phone and really encouraged me to Appeal so I hope that's what it takes. Silly me I really went into this thinking that if they approved the Lapband removal there was no way they wouldn't approve the revision to the Sleeve. I started the pre-Op diet after being denied right away as a back up plan so worst case I hope to be fully approved by mid February. 2bfit - Congrats! So happy you were approved. Raquel - I hope you hear the same news on Friday - keep us posted. Thanks. Susie

I have seen some who have posted and were willing to share their appeal letter that helped them get approved. I would so appreciate it if you would inbox me if you are willing and I will pay it forward. I was approved by United Healthcare to have my Lapband removed but not to have the Sleeve. I will give them credit in that a Care Coordinator follows up with me regularly to see how I am doing. I moved to a new state so had to find a new Primary Dr. and saw him for the first time a month or so ago to officially start a 6 month program which is supposedly the main reason they wouldn't approve. The Care Coordinator also had me talk to a Behavioral Counsellor and both seem to be very caring and understanding of my situation and have encouraged me to appeal. I do plan on appealing but my former Primary requires me to send a letter to obtain my records and I have not done that yet - but will do tonight or tomorrow. I did obtain records from my former podiatrist for plantar fascitis treatment records as well as my former Bariatric doctor to demonstrate the care I had in the past (my last fill was in 09/09 though) after which I pretty much gave up on the whole thing. Anyway, I want to get started with the Appeal letter and have a good idea of what to say and I have lots of receipts from any number of diet plans I tried even while having the band due to my lack of weight loss -- WW, Medifast, Nutrisystem, etc. I felt so vindicated when my new surgeon read the results of my Upper GI and saw that the band had slipped and isn't even sitting on my stomach - it's on my esophagaus which explained why I was never feeling full nor had restriction - though food still got stuck at that point. Thanks in advance to anyone willing to help. Susie

Well I finally did it. I mailed my Appeal Letter on Tuesday - it took quite while to get some of my former medical records from NY. According to UHC's policy they will respond within 15 days for denials prior to surgery being done vs. 30 if the surgery was already done. So I am hoping and praying the letter convinces them. I was able to take advantage of the helpful info others shared so a HUGE THANKS to those of you who responded. When I get the final decision - and hopefully a positive one - I will be happy to share my letter to those who are interested via email. I really hope to be able to move forward in the process. Considering the denial was based on not having the 6 months physician supervised weight loss program - and I'm now already almost 3 months into that, worst case I should be approved when I complete that in mid February. I strongly feel that I shouldn't have to do that considering I lived with the Lapband for 5+ years and they already approved removing that but denied the sleeve because of not having the 6 months pre-op diet. I'll keep you posted on the response. Thanks again - I am so glad I found this Board - I have and continue to learn so much from the posts here. Susie

Band2Sleeve: Wow - you are very fortunate. I am almost two months into my pre-op diet and still plan on appealing to try and get the surgery sooner but am waiting on paperwork from my former Primary Dr. What complications did you have with the band that led up to them approving the revision? My band removal has been approved; but not the revision. All because of not having the six month pre-op diet. I have reflux and esophagal dialation, plus it slipped up on my esophagus so isn't even on my stomach. Thankfully just having it unfilled completely has made a world of difference in living day to day until I can get this thing out of me - and I definitely do want it out! Just wondering if you had more serious complications like stomach erosion that led them to approving the revision so quickly. Good for you for having such a great plan and insurer. Thanks.

What insurance company do you have? I have United Healthcare and they are requiring this. I think it is absolutely ridiculous and intend on writing an appeal letter. I recently moved so am waiting on receiving some of my old medical records from my previous state to include with the appeal letter. My Lapband removal was approved but my revision to sleeve was not - because of not having the six months pre-op diet. Like you, I feel like having a LapBand for the last 5+ years should qualify as my diet. What's even more ridiculous is that the denial stated that the diet had to be supervised by a doctor who does not perform weight loss surgery. Why would I go to another Dr. for weight loss when I already had weight loss surgery? Just to cover all angles though, I found a new Primary Dr. in my new State who will support me for the surgery and started on a plan about 7 weeks ago. He is well versed in how the process works so he is making sure that he writes in his notes what I am doing and the results. I hope you don't have the same requirement. I fully understand it for someone who has not had WLS and I went through it before to get my Lapband approved originally; but for revisioners it makes no sense. I chalk it up to just another stall tactic so I will be appealing even if I'm almost done with the six months by the time the appeal decision comes through. I hope your insurance or your employer's requirements are more sensible then mine. Susie

Thanks for asking and any other suggestions you may have. Here is the specific wording in the denial letter: "Diagnosis: esophageal reflux,vomiting, abnormal weight gain Type of treatment: longitudinalgastrectomy The service is not recommended asmedically appropriate for the following reasons(s): Authorization for Sleeve Gastrectomy isnot recommended, as clinical criteria for this procedure are not met.For example, per SPD: Recent history and documentation in MD notesthat the pt has participated in and reasonably complied with at least1 physician-supported weight loss program (including nutritionalanalysis, education and regular clinical encounters with a healthprofessional), documented by a physician who does not perform weightloss surgery, lasting for a minimum of six (6) cumulative months andoccurring within two years prior to surgery. Also dietary therapy,i.e., restricted calorie diet, increased physical activity i.e.,exercise program, behavioral therapy to reinforce dietary therapy andincreased physical activity."

Those are both great. Thank you so very much for sharing! Susie

Thanks LML for all of your advice. The Sleeve is definitely not an exclusion - they are mostly honing in on wanting me to be under a physician supervised diet plan for six months. I'm already one month into that anyway so worst case I should be able to qualify after the beginning of the year even without the appeal. I like the idea of getting the other Drs to write letters - I have records but will ask for the written support also. Thanks again. Susie

I am so glad to have found this forum - especially for Band Revisions. I have been considering the sleeve for some time but have just begun to act upon it. I had LapBand surgery in March 2006. I never did lose much weight - 44 lbs at the most. I did well for the first 9 months or so and I completely fault myself for not having more success - but there were many personal and medical contributing factors as well. In any case after going to two different surgeons for years and having numerous fills and unfills, it has taken its toll - at this point I have not had a fill in probably close to two years however I know I still have restriction because food still gets stuck and I can only eat 1/2 a meal. Like so many others I am sick and tired of being embarrassed at restaurants - having to excuse myself from the table with a panicked look and hoping that no one is in the rest room (I travel a bit for work) amongst other things. My husband says everytime I get stuck - 'why don't you just get that thing taken out of you!' I've gained back all but 12 pounds. I started eating around the band and essentially sticking with soft foods; ice cream always soothed my throat after stuck incidents (and beyond that). While many people have trouble eating Pasta with the band, I never did and that became another food which was much easier and less risky of getting stuck then meats. I know two people who had the sleeve for a few years now and they did fantastic and have kept the weight off - and I would guess that one of them lost 250 lbs or so though I never specifically asked her. I like very much what I have read here from those who have gone through the revision. I like that the as part of the sleeve surgery the portion that contains the ghrelin hormones will also be removed. I've never been willing, no matter how desperate I've been to have RNY -- though I expect if I had co-morbidities that needed immediate attention I would feel much differently. I have just moved to the Orlando, FL area (from NY) and started researching surgeons. I went to a seminar held by Dr. Marema last week and was very impressed. Their office took my insurance info and set up an appointment to call me today to tell me whether or not my insurance (United Healthcare-Choice Plus) would cover it and what my expected cost would be. I already have an appointment with Dr. Marema on Tuesday because I discussed with them that I am very concerned that with all the vomiting over the years that my esophagaus (sp?) may have become damaged. They think that it may come down to him writing a letter of Medical necessity to get me approved without having to go through all the usual requirements. They did call right on time today and told me I would be covered by my insurance and what my copay would be. Even though I am hoping not to have to go through any six month diets (haven't I technically been on a weight loss plan having the Lapband for 6+ years now?) the soonest I will schedule surgery is September due to some work coverage issues and the fact that I'm booked on a cruise over Labor Day and would be concerned about medical let alone eating issues. I don't mind if they send me for the Psych and other tests again as long as the wait doesn't drag on and on. I'm interested in hearing from others who qualified for surgery quickly due to band issues. I can honestly say that I am concerned over my esophagaus, sick of food getting stuck, I have severe plantar fascitis and can hardly walk at times - have gotten cortizone shots for years and am now talking with the podiatrist about surgery for that. My BMI is 49.4. I do not have high blood pressure, diabetes or any major comorbities - though I occasionally have reflux. I really want to make a fresh start. I know the mistakes I made with the Lapband and I won't repeat them. On the bright side I know what to expect in terms of eating plans, etc. Actually my usual Breakfast for years has still been Greek Yogurt. I am looking forward to not having an appetite because right now I may fill up fast with Protein but will be completely starving within 2 hours. Appreciate all and any advice. Thanks so much to all those who respond. Susie