ShellieB73

What's up with the "AND" stuff.......really......that is extremely frustrating!!!!!!!!!!

Is there some concern that if the policy changes that it won't take effect until January 1, 2011. Is the general feeling that the policy will be changed? Lord have mercy........

Wellmark - BCBS in Iowa isn't covering yet either, but they are due to revise their policy this month.....I am patiently (not) waiting.....and stalking the website daily!!!!!

I'm holding my breath for a revision to Wellmark's policy sometime soon....I am in IA and I hear about surrounding states getting approval for the sleeve through BCBS. Anyone have any inside info? Thanks.....

Many congrats and thanks for the information....I am waiting for the traditional Wellmark of Iowa policies to be updated as well. I have been contemplating submitting and then asking for an independent medical review if denied, but I have a feeling it will be soon!!! I guess I am trying to be optimistic Meanwhile...I continue to be frustrated with myself after removal of my band.....argh!!!!

I'm so hoping that Wellmark BCBS of Iowa will hurry up!!!!!! My patience is wearing thin!!!!!

When I had my lap band done I got a huge bill from the hospital despite getting pre authorization.... I called the hospital and asked for an itemized bill and found that they had billed for two actual lap bands. I kindly informed them that I did not have multiple stomachs like a cow and the problem was fixed with in about 6 weeks. Sometimes if the charges are over what seems to be customary, they will kick out the claim.

What if you had the lap band done under another insurance, they paid to take it out (due to slippage) and now you have new insurance (Wellmark). What's the chances of having to meet the criteria for weight loss surgery all over again? UGH!!! I did that once and now have to jump all through the hoops again to get a revision. ARGH!!!!! This is so frustrating!!!!!!!

I just received a return call from Wellmark on Friday...the gal was really nice, but no real helpful information. I know the current policy was revised in Sept 2009. The gal told me that they typically do revisions on policies every couple of years OR if they receive literature or information from surgeons, etc that would warrant changing it sooner. I say barrage them with reliable studies that support VSG and see if that persuades them to update their policy sooner than later!!!!

SpringerLink - Journal Article Just thought I would share a link to a an abstract for an article published recently. I thought the results were pretty promising, and although the sample size was small, at least it is favorable for weight loss stability at 5 years and plasma ghrelin levels staying low. Now if we can get insurance to make some changes!!! Just wanted to share.... Shell

I think I asked this same question when I was researching the band..... Is there anyone on here that has personal experiences to share after being "sleeved" for several years? The band seemed like the thing to do Feb 2008....not a lot of complaints or problems (or none that I distinctly remember). Now pretty much everyone you talk to who has had a band for greater than 1 1/2 or 2 years is having some sort of nuisance issues or had removal, etc. I am seriously considering the sleeve, but I dread getting 2-3 years out and having issues that can't really be reversed. (I had my band removed in March due to slippage and have no problems resulting from my 2 years being banded.) Anybody's thoughts are appreciated....shellieb

Anyone know anything about Wellmark/BCBS in Iowa and where they are as far as covering the sleeve? I heard that it was in committee. It seems that BCBS in other states is covering.....

I can't believe that some companies will say one WLS per lifetime....that seems so discriminatory. We are people trying to get healthier!!!! Is this going to become the standard? I have a hard time believing that because of a mechanical failure (slippage) in a tool that worked at the time, it would completely disqualify a patient from another procedure. What is health care coming to?

I can so relate to the initial post here..... I was banded in Feb 2008....did absolutely wonderful until November 2009. I had a slip that was discovered on a routine UGI. Looking back I did have some sypmtoms, but overall had lost 80 pounds and was maintaining without any difficulty. I had my band removed in March of this year....after the roller coaster insurance battle. The technically can't deny removal of the band as it could potentially be life threatening (rare, but possible to have part of your stomach become necrotic). The refused to replace the band because I was no longer "morbidly obese". My surgeon was about as frustrated as I was!!! Now....after gaining since November....I am pretty close to the BMI of 40.....frustrated, mad, depressed....blah blah blah!!!! My dilemma now is that I live in Iowa and the sleeve is not commonly done here. My surgeon is doing them, but insurance coverage is spotty. Due to a job change, I am getting a Wellmark/BCBS product beginning May 1st.... Does anyone have any information about Wellmark in Iowa covering the sleeve any time soon? Honestly, I don't see why they don't....it would be much better from an insurance standpoint. No fills, no frequent appointments....it is a much better surgery, I believe. thanks for letting me rant.... shellie

I'll try to make this brief.... I had Lap band surgery 2.2008...lost about 70 pounds very easily. Had a slip 11.2009....removal 3.2010. My insurance at the time would not pay for a replacement of the band because I was no longer "morbidly obese"....even though I didn't get to goal. My surgeon talked to me about the sleeve and I have been seriously considering it since November. Also, I have gained back nearly 30 pounds since November. I am getting new insurance due to a job change May 1st. I am praying that they will cover WLS for me and specifically the sleeve. My problem is that my surgeon does not operate at a "participating facility", so my options are to pay a 40% copay and the non participating facility or find a new surgeon. Is the 40% figured on the allowable charges or on the billed charges? We all know that insurance doesn't pay the entire billed charges, but usually cash pay patients do unless there is a prompt pay discount or something similar. Has anyone had any of these similar issues? I wish I could find some more concrete literature on the long term success with the sleeve. Specifically, are there any issues with ulcers, strictures etc. Guess that wasn't real brief, but I'm really feeling desperate due to my weight gain. It is so discouraging and I physically feel lousy!!!! Thanks....shell