brittu

So I have a band that worked great for 18 months. Then I stopped losing weight and found out this winter that I had a dilated pouch and probably a small slip. I'm fighting the insurance company who doesn't want to take it out or revise to a VSG. I suspect I'm going to end up being self-pay after months of angst but that's another story. I was in la-la land with the band for the first two years. It was working so I just ignored how unpleasant it was. Sliming and vomiting. Heartburn. The contant feeling of swelling. Even on a fairly good week eating solid foods isn't that pleasant. I can always feel the food sit waiting to make it through the stoma. I'm never sure if it's going to get through or not. I can't lay down after eating. Mostly if I'm eating healthy food I'm thinking about trying to avoid discomfort. I don't think I really feel full like I expected. I should have clued in when the surgeon warned me that I'd have to learn the new signs for being full with the band. I thought I'd feel satisfied after eating. Sometimes I do, sometimes I can eat more and don't. Sometimes I'm in pain and vomiting not knowing when whatever is stuck in there will make it down. The sleeve is a serious choice. It can't be undone and if I'm self-pay I'm taking a big financial risk. I thought I did my research on the band but I didn't pay too much attention to the side effects. Like everyone I assumed it would never happen to me. The idea of having to be uncomfortable when eating for the rest of my life - I'm not sure if that's something I can live with, even if I get to a good and healthy weight that I can maintain. I know that foamies, pain with overeating, and other things can happen with the sleeve. But what does it feel like on a day to day basis? How much of the standard discomfort I feel with the band will I feel with a sleeve? Will I feel food sitting around? Or food kind of up in my throat? How about the feeling of pressure or the near-constant feeling of swelling or inflammation? I just want to know what I can realistically expect my life to be like if I woman-up and go for it :-). Thanks, Britt

I was thinking about a leak or infection that's not detected during the initial hospital stay. Or some other related stomach complication like cancer or reflux - anything that the insurance company could claim was related to the partial gastrectomy and therefore not covered. Usually I have the will to fight. But I just want the band out. I called Dr. Cirangle's business office today to find out what my portion of the cost of revision would be if the lap band removal was covered. I think that'll determine a lot about what I'm willing to wait for vs. what I'm willing to pay for. I'm at the point where $11k feels easier to come by that creating more paperwork and wading through two more rounds of appeal... Especially since I have confidence in Dr. Aceves and also feel better knowing that I'd be under care for 3 days after surgery and not just sent home asap. Even though I'm only 25 pounds away from the BMI requirement I just can't gain that weight again. It's not worth the money. I had to fight a bit to get the lap band covered the first time around with a different insurer, they didn't agree that my comorbidities justified the band. So my BMI went up from 35 to 38 while I battled it out. It was so demoralizing and it seemed so stupid - the general implied advice that if I just gained more weight my surgery would be covered without question. I definitely appreciate everyone's input. The sleeve seems like exactly what I hoped the band would be. I'm just more cautious this time around. And scared I guess that even if the VSG feels better what if it doesn't help me lose more weight. I wish this all wasn't so hard! Thanks, Britt

Thanks Wasa, your input is really helpful! Unless I gain another 30 pounds Fed BCBS isn't going to budge on fixing this. I got their appeal acceptance and they totally threw down the gauntlet to make sure I knew that the 35 BMI was non-negotiable. I'm guessing I will eventually win having them take the band out but that won't help much since my doctor here does explant and vsg as two separate surgeries six weeks apart. And I can't seem to find anyone except for Dr. Cirangle who'd do it all at once and just charge me for the additional procedure cost. But I understand that he has an $8k post-op program which would put me back up higher than just scheduling with Dr. Aceves in the first place. I need to check on that but Dr. Cirangle's business office never returned my calls or emails after I had a consult with him and my first conversation with the coordinator. I completely trust Dr. Aceves and would be happy to go to him. But I would worry about some future complication that the insurance company would refuse to cover. Ah, why does it have to be so hard. What I meant by the VSG can't be undone is that if a few years from now some complication occurs my stomach can't be restored. I don't know what problem could come up, it's just that I'm a little more cautious this time around. Thanks again! Britt

Hi all, Well thanks to the great help from the boards, I've got my appeal letter ready to ship off to BCBS. Anyone want to take a look? Offer me some advice? I've posted it here: http://vsgappeal.blogspot.com/2009/06/introduction.html ...and would love to get your in feedback. Thanks, Britt (forgive the multiple posts, not sure which areas get the most traffic)

Hi there! I'm working on my insurance appeal letter. I have a lap band that's failed (slip plus pouch dilation) and want to revise it to a VSG. I was denied on three counts. First, the removal of the lap band was denied because it wasn't deemed medically necessary. I figure maybe the insurance clerk who decided this ought to come and offer to hold my hair during the 4-8 hours per week I spend bent over the toilet sliming :-). They denied revision to VSG claiming that VSG was investigational. That makes no sense because I have Federal BCBS who have been covering VSG since 2008 and I just think that's an error on the local administrator's side. And they also denied it because I'm no longer > 35 BMI - well "no duh" my lap band helped me lose weight before it slipped. I can fight the lap band removal and "not morbidly obese enough" part pretty well and have written that part of the letter. But the part I'm struggling with is any additional documentation to fight the claim that VSG is investigational. So... Does anyone have verbiage from their appeal that they can share? Or a pointer to a published medical opinion or study that I can point to? Any help appreciated! Britt (Sorry for the other posts if you also frequent other boards - I'm trying to cast a wide net.)

Well hang in there, my fingers are crossed for you. Someone replied on one of my threads that they finally had success with appeal 3 when they hired an attorney to help and won. They hired Walter and Kelley Lindstrom and it sounded like their written appeal was so effective it just turned the tide. The blog posting I got good information from was from Teresa at ObesityHelp: The Diary of a Fat Woman: Deny Deny Deny! Here's macmadame's great set of links: MacMadame's Profile And then you can google phrases like "vsg insurance" "vertical sleeve insurance" and then "appeal" and the like. You can also google terms for VSG + the name of your insurerer and/or state and see what you get. Best of luck! I'm pullin' for you. Britt

Thanks to the help of people on various boards I made many edits and finally decided to just get it done and sent. So it's off in the mail as of this afternoon and now I'll just wait and wonder until I hear back from them. If I had to place a bet it would be that they'll agree to remove the band but refuse to pay for a revision to VSG by moving the low BMI determination to their denial of the VSG. But at least I'll feel like I did everything I could. My husband asked me last night what I'd do if money didn't matter and my gut feeling was that I'd choose Aceves. He's so highly thought of and has such great experience. I'd rather not have to pay for the surgery (I'll have to use the money I was saving for a kitchen remodel). But in the end I know it's worth it. I was so thrilled with the lap band when it was working. I already know how life changing being able to manage your weight and eating is. I've updated the blogspot content to match what I finally submitted. That way if there's anything useful in what I put together it's available for others to cut and paste from. Britt

The TOS issue was resolved on a blogspot review. For new bloggers and new posts they do a scan to see if there are any words that trigger an alert for misuse by spammers and stuff. Everything was fine. Really sorry that it caused problems. I never blogged before.

Thanks Keith. I finally finished it off (and reposted the final version) today. It's now on it's way to the local BCBS. I actually expect that they will offer to remove the lap band but deny the revsion because I'm not >35BMI. Seriously, I think a lot of the insurance issues are related to weight discrimination. Pretty much any other diagnosis and and if the first treatment failed you'd have no problem getting a different treatment. Heck, if I had the symptoms I had without a lap band they would have been all over getting me in and covering whatever it takes to fix it. For the Fed BCBS stuff I posted on a few boards asking for others who were covered and got several public and private responses. I also did lots of googling on the variants of VSG and Fed Blue to find people who had been covered and the name of their doc. Then googled or looked up on Obesity Help a lot of the docs that were mentioned. Then called around to see what the various doctor and BCBS offices said. There were three states where the local BCBS administering for Fed Blue plan seems to have issues including Washington and California. In my state there are two BCBS offices that share administration of the plan and they disagree. The phone people are in the BCBS company that says it's covered but the pre-auth people are in the other company and say that it isn't. What's really frustrating is that there seems to be no Federal oversight of the plans that I could write or call to get this sorted out. I didn't include the doctor's names in the post because I didn't want to cause them any trouble in case they were using one of the old CPT codes for VSG (before it had an official code). And generally didn't want issues to come up in the states where VSG has no problem. If money wasn't a concern I'd probably already have gone to Dr. Aceves. But my hangup is what happens if I have a leak and need very costly emergency care. Who would pay for that. So if I can get some sort of coverage then I'll go with Dr. Cirangle in CA. There are a few local doctors here who do VSG but they just don't have the experience with revisions that Aceves, Cirangle and Hargroder have. I didn't really know as much about VSG and revisions when the pre-auth was submitted by the local doctor. It would be great if he could do it but they've only done about 100 VSGs and they want to do it in two surgeries six weeks apart. I just don't want that if it can all be done at once. And, heck, it's less than a used car if it comes down to self-pay for me. Well worth it. I loved my lap band while it worked. I think you should continue to fight on appeal. How good were your surgeon's notes? Will their office write a letter saying they had no choice? Much of the VSG info I used I got from Teresa who has a blog where she put her letter. I just added to it and wrote my own version. Also macmadame had posted a great list of studies and details that I referred to. Congratulations on your weight loss and improved health! It's amazing to feel like you're in control isn't it? I wish things could have stayed that way for me. I want to kick myself for not trying to get control before I regained so much weight. Britt

Hi WASA, What's funny is that they didn't deny the VSG for the BMI reason, the denial letter states only that it's investigational. It's the removal of the lap band that they denied because of the BMI. Isn't that funny? Like no matter how much you're suffering you have to regain the weight AND vomit and not be able to eat to get the danged thing out. Or be lucky enought to have a slip before you lost much weight :-). Even if they brought out the BMI argument for the VSG I'd still fight them - I had a gastric restrictive procedure and it needs to be fixed so that I have gastric restriction again. My original surgery was covered and I met all the requirements so it seems like a continuation to me, not something new. If I went and asked for breast implants I'd be denied. But if I had breast cancer and a mastectomy and a year later asked for breast implants I'd be covered. They wouldn't deny me because I no longer had cancer. ahchancey, Would you be willing to share the doctor and/or state in which you had the revision? Part of my argument includes a list of all the doctors I've found with Fed BCBS patients who were approved for VSG. I've been calling the local plan admins in those states and confirming the coverage. So far, everyone says no problem. Of course my state admin said no problem too. They actually have two separate local BCBS companies doing the admin here and I think that's part of the problem. The group that does the customer service told me it was fine but the company that handles the pre-certs says it wasnt' and the other company was wrong. Sigh... Almost every day I think just screw it and I'll go see Aceves and pay for it myself. But now I've almost got the letter done, just need a blurb or two on why VSG is safe and mainstream and I'll send it off. Then I'm done and I'll either get it or book my trip to Mexicali. If I won the lotter I'd just book my trip and get goin' :-). Britt

What a great thread! I had my band in August of 2006 and did great for the first year or so. I got down to 164 from my high of 236. In April of 2008 I had a fill after gaining about 10 pounds. Over the course of the year I gained another 10 and finally ended up at my doctor's office in March of this year. I had a stretched pouch and inflammation and was completely unfilled and sent home on two weeks of liquids. I went and had a endoscopy to see if there was any additional damage. And gained myself another 15 pounds in the process. I'm up 35 and unbelievably discouraged. Today I went for a fill with fleuro. It was clear that the little 2ccs I was up to after the unfill wasn't restricting anything - the barium just sloshed on through. They added .4 and it looks really good now. When I got in the car I had one of those aha moments. My band hasn't been providing me with restriction for over a year now. Now wonder I gained weight! I was right back where I was the year I'd lost and regained and decided to get the band in the first place. I feel really relieved. I needed the band to lose weight and I need it to work to maintain. That's just how it is and I can't beat myself up over it anymore. Now I'm looking forward to getting past the liquids and mushies so I can see if it's really working again! As far as getting back on track I'm trying a few different things. A few years ago I did a weight loss hypnosis programs. So I reordered the sessions on CD and have started listening again. I can definitely tell a difference in my motivation and control the day after I listen to the program. I also started logging my foods online (I've been trying Spark People and Daily Plate). If I really do have restriction again then it'll be more about keeping on top of my nutrition and Protein intake and keeping alert for excessive snacking. In November I rejoined the local health club and have been doing Pilates Mat 2-3 times a week. What's interesting is that I'm back up to 199 but I'm not the same size I was the last time I was this weight. So even though I can't see it, it must be working under all that extra padding. Now I just need to add cardio. My husband is a real nag about exercise, we've got an elliptical and a treadmill in our home so it's hard to tell him no. I'm also back to the support groups. I have to figure out why I overeat and work on it. There's another support group I'm going to try on the 13th and I'll pick the one that works best for me. I also went to look at the FACE Weight Loss program which appears to be a non diet kind of program. And I was thinking about buying that Gabriel Method book. At any rate... I'm so glad this thread exists and that I'm not alone in struggle to relose my regained weight. It helps a lot. Britt

Why can't you have a fill sooner? I had a problem with my band and was unfilled and have regained some weight. I'd planned to revise to a different WLS but the insurance company is fighting me since I'm no longer a 35 BMI. I think what set me down the path is not being filled when I needed it. I'm getting refilled slowly, another one tomorrow, and hope that once I get back the restriction I had for the first 18 months I can get back to losing again. It's been very depressing. I've also started tracking what I'm eating online and that helps a lot. I've been trying out Daily Plate and Spark People. I've also found that attending Weight Watchers is helpful as is attending a lap band support group. Britt

I love both Wendy's chili and Taco Time's chicken chili. A small Wendy's chili with crackers, cheese, and onions is a very satisfying for me. And the calories go down without the crackers and cheese. Once in awhile I'll have a burger without the bun or with just half a bun. Mostly I try not to eat fast food because I have to fight myself to make good choices there. And because fries and buns and pizza have gotten stuck way too often to be appealing... Britt

I second the suggestion to try the powdered Peanut Butter. I've tried both Fitnutz and PB2 and like them a lot. Only about 50 calories for a serving. I like using it to flavor other foods, haven't actually tried making spread out of it since I don't really want to eat it on carbs. I was thrilled to find it. Britt

Oh wait, I see you have been doing liquids for weeks and you've had a GI. I agree, you should talk to your doctor. I ended up having an endosopy to take a closer look at what was going on inside. Is that an option for you? I think it would be good to get some medical help to figure out what to do... Britt

It took a total unfill and two weeks of liquids for my swelling to go down. You might just need to give yourself more time to heal... Britt

My BMI is 31 and I'm planning a lap band to VSG revision. I started at 236 and got down to 164 but have been steadily regaining since my band "failed" this last year. I wish I'd done it after the first 15 pounds rather than my current regain of over 30. Britt

I keep reading that Fed BCBS is covering VSG. I've found over 10 patients who said it was covered. But for me they denied it saying it was investigational. I'm fighting them but it's making me crazy.

That makes me so mad! Weight Watchers actually now supports people who've had weight loss surgery. You can search their site and see their info. I thought this was particularly interesting. "Lifestyle modification is the cornerstone of the Weight Watchers approach– making wise food choices, being physically active, developing positive thinking skills, and being in a supportive environment. These four pillars are especially important for those who have undergone bariatric surgery." My WW team is very supportive of WLS, they've even asked if I would be interested in being a leader there some day. WW is a great program and I think works very well with the Lap Band. Honestly, it's like the women who say you can't enjoy the birth experience if you have an epidural. You use the tools you need in your life to get to your goals. End of story. If I could find that dang post I'd give her a piece of my mind! Don't you let her small minded pettiness stop you. If you find WW useful then you do it. Britt

I take the All One brand of powdered Vitamins. I read that powdered were better for you because they don't need to use the preservatives or binders that chewables and liquids have. I actually take the "senior" formula because I liked the extra things it had. I can definitely tell an energy difference on the days I remember to take it. Swansons seemed to have the best online price. Britt

Have you discovered powdered Peanut Butter yet? I orderd some Fitnutz and PB2 to try and they're both great. About 50 calories for a serving vs. 190 for regular. I love adding them to my Protein powder or low fat ice cream. Real peanut better is better but just ends up being too many calories for me. Britt

Hi folks, I have a lap band that was placed in August 2008. It's been great but I recently started to gain weight and found out two weeks ago that I had inflamation and possibly a minor slip. My doctor is about two hours away and is no longer covered by my insurance. So I ended up seeing Dr. Billings at Puget Sound Surgical today. He says I could replace my band with a larger band (which seems to have less issues with slippage) or revise to a sleeve but that my surgery looks well done and I could probably do just fine with the band I have. He suggested starting with their year long aftercare program. I'm going to have an endoscopy on Friday just to make sure everything looks good inside. Here's the problem. A revision would be covered by my insurance. But Puget Sound Surgical doesn't bill insurance for after care. It would cost $3,500 for a year of nutrition and behavior support. montly doctor follow-ups and fills. That's a lot of money but my husband is open to it if that kind of care would help me get back on track and losing to my goal. Has anyone gone to Puget Sound Surgicals after care program? If so, could you share your experience and whether it made a big difference to your success? I could continue with my current doc at $250 a visit an a 5 hour return trip travel. Or I could just visit the nutritionist separately. Or I could just cough up the $300 per month for aftercare and really commit to it. I'm not sure what to do. I can't find any other docs around here that would take on a lap band patient banded by someone else locally. But if you're in the Seattle area and have a doc who takes on pre-banded patients I'd love to hear from you too. Thanks! Britt

I think clothes can really make a difference. I was still wearing a size 20 when I went to buy some new clothes and came home with a size 14 pair of jeans and 12 top. It was shocking. I felt like I came home from the store in a new body. My husband was speechless and you should have seen people at work the next day. I had no idea I really looked like a regular sized person. If I'd been getting some clothes on the way down I might have realized how much I was changing along the way. Britt

I've had my band for almost 3 years and had 100 pounds to lose. I did great at first, down 75 pounds and then had a problem with my band and gained back almost 30. To be perfectly honest with you, if VSG had been as wide spread then as it is now I might well have chosen that instead. And if my band problems get worse I'm very likely to revise. The band is great in a lot of ways but some foods don't go down well and things don't always feel great when I eat. I definitely didn't want anything that affects my ability to absorb and process nutrients and the band was the best thing at the time. But in the long run I'm guessing VSG might be better. People who have it seem to love it. Britt

I got stalled, had a problem with my band, and gained 30 pounds. Grrrrrr. I wanted to jump start two so I'm trying three things. First, I'm back to a support group so I have to be accountable and keep thinking about how to use my band correctly. I've upped my exercise. And lastly I did a 9 day Isagenix cleanse. I don't sell it but I learned about it from a friend. It went well and I lost 5 pounds and felt great. Loved the shake and just got the 30 day program. It's simple and is just what i needed to give myself a jump start and get as healthy as I can. On my latest order I added bars and Soup. I'm eating one healthy meal and one snack a day. I look forward to the meal and choose carefully - low fat Protein and veggies are very appealing when they're your one meal of the day :-). They have another plan that's 2 meals and a shake or bar a day and I'll evenually work up to that one. Anyway, for what it's worth, it has helped me to do a cleanse and sort of reset my mind and body both. Britt