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I got the labband in 2007. Had had some success with it, lost and have kept of right at 60 lbs. I have struggled with the usual problems that come with the band, heartburn, acid reflux etc. Well it was determined about three weeks ago that my band has slipped. The Doc recommended removal and revision to RNY. It request was submitted to BCBS for approval. Received a copy of the letter, and they have approved the removal but not the revision. I do not meet the criteria now. I have worked hard to losse this weight and try to keep it off, and I know without the band or something I will gain all of the weight back. I have been unfilled and it is already starting to happen. My lapban surgery was with a diffrent insurance not BCBS so it would be my first WLS with them. The criteria says that I have the diagnosis of morbid obesity for a period of 2 years prior to sugery, duh, I had the band and got my weight down; My bmi is now 33, so still suffer from obesity but not morbid obesity with a comorbidity I no longer have a problem with blood pressure like I did before I am no longer borderline diabetic I still need to loose about 50 lbs Has anyone else had this problem and how do you fight it? Thanks, Laura

I have UHC and I'm a railroad employee (BNSF) I had the lapband back in 2011 and they covered it 100% no deductable, no copay. Then in Jun 2012 insurance changed. I had a revision from band to sleeve in Jan 2014 and had to pay a deductable and copay ( it came to about $900.When I went for my lapband I just had to document my weight loss attempts over the years. UHC was very easy to work with on getting it covered.

I was approved for the sleeve last month and my surgery is actually scheduled for Tuesday. However I got a call from Cigna on Friday afternoon at 4:30 (lovely timing) saying that although they approved it, that particular code for the sleeve was excluded per my plan. They are saying it won't be covered now. I'm going to have my docs office call first thing Monday, but I'm thinking if there is no budge on the sleeve coverage, maybe they could switch to bypass and I could have that done Tuesday instead? I believe it's all the same WLS requirements and I know my plan cover bypass for sure. Anyone else go through this and got a switch quickly? I'm freaking out and devastated after all this time and planning it may not happen.

Basically what happened is.....I have UHC, but this particular plan does not cover bariatric care at all. So, I paid for the surgery myself. Well, in order to get insurance to pay on the surgery, they billed "unlisted liver procedure" instead of wedge liver biopsy...."unlisted procedure, stomach" rather than gastric bypass...."adhesion repair" rather than lap-band removal...and also charged for a (hiatal) hernia repair. Mind you, all of those things were to be INCLUDED in my revision surgery (that's why it's more expensive than a "virgin" bypass), but they had my insurance information from my (original) consultation and submitted it. Since the coding "appeared" medical, UHC covered a pretty significant portion of it. Thinking I should get a refund for anything that insurance DID pay, I phoned the office to find out when I'd get a refund check and, to my surprise, they said they would be keeping BOTH payments! Adhesions were expected, due to the band; I've had a hiatal hernia for OVER 10 years, but the op report reads as if it was "discovered" during surgery!!! Adding what they billed insurance PLUS what I paid up front, my surgery was nearly $58,000!!! That is ridiculous. The average for bypass is $22,000, which is what I "self" paid prior to surgery. Just a side note....I had NO complications, NO unexpected/unplanned procedure and the hospital and anesthesiologist both wrote off ALL charges except what I paid up front...only the surgeon billed/was paid by my insurance company. I tried to "appeal", but UHC wouldn't since it was not a denial. The insurance commission only regulates insurance, not MD's. The Medical Board only cares if you have "injuries" (for malpractice), they don't care about how the MD codes the surgery. Most patients don't mind because, had UHC NOT paid, they would not have billed me anything....they would have just " settled" for what I paid them up front. Because the patient usually doesn't get a bill, most don't mind and/or don't complain when the doctor submits "medical" codes and gets payment. It is a common practice by bariatric surgeons (even the "good" ones!), but it's wrong, wrong, wrong. I am continuing to pursue it because I work in the healthcare industry and I am just so infuriated by all the fraud, abuse and waste in "the system" that I am not going to let them get away with this, even though almost all of them do it!! Sorry to go on and on, but I am just SOOOOO frustrated and angry that I go on a rant when I discuss it. I asked all the right questions, reviewed the contract, etc., etc., and I STILL got "used". I am still trying to work with UHC to either ask the doctor for a refund or else tell him he needs to refund it to me...even if I don't get it, I don't want the doctor paid twice. If your insurance doesn't cover your surgery and you end up paying yourself....BE SURE that you have an "iron-clad" contract and understanding with your physician about what will be billed and HOW it will be billed. As a side note, even my PCP said it's "illegal as hell" (quote, sorry for the language) the way they billed it; it's not just me being upset because I didn't get a refund.

Just out of curiosity why does bypass scare the crap out of you? I was going to have the sleeve and then because of reflux we decided the better surgery for me was bypass. I was scared to death to because all of the horror stories. I spent some time with both my bariatric team, my gastroenterologist as well as many bypass patients. I was most afraid of the malabsorption component. I then learned very quickly that it actually helps you to lose weight and honestly both bypass and sleeve patients have to have blood work and take Vitamins for life. The biggest thing they warned me about was not going in for yearly nutritional panels and skipping vitamins. As long as you do that which you also have to do with the sleeve as well, you should be good. I am two years post op, have lost all my weight and comorbitities, am very healthy and thank god every day that i went bypass as i have not even had a simple case of heartburn since the day i woke up from surgery. Spend some time and really research so you make the best choice for your health. I have seen way too many sleeve patients then have to revise to bypass anyway. I decided i was only going through this one time in my life. Both surgeries are equally as aggressive. The sleeve removes 90% of your stomach, the bypass reroutes. Just my two cents....take it for what it is worth but don't be afraid, be educated about your choices.

Sorry girly I'm just testing out my posts and you were a easy target. Next time I'll go after a pot smoking bypass patient??

I , for one, am grateful. I had complications and had to revise to bypass and have felt like I "didn't belong" anymore. Different issues, etc.

revisions always seem to be slower than virgin surgeries. That said, you can always lose more weight by cutting calories....I mean if you're willing to do that (I know I could lose more by cutting them, but evidently I'm not willing to do that because here I sit....still 10-ish lbs heavier than what I want to be...)

hope you are having luck on your hunt to find someone to cover the revision. Have you called http://www.legacyhealth.org/weight ? I am going through them. There staff is very nice and helpful. Give them a call. talk to their insurance guru. She may have a few insurance companies that cover those costs. If not, look into a self-pay outside the US?.?.?.

I can't. Tell since my port revision surgery yet. When my port flipped it was sticking out sideways and looked like a hernia. So I had to have a revision and I think it's above my belly button. Not sure though.

Well I was all set on the LapBand and then I met with my nutrionist who started to sway me towards the gastric, because I will lose more, and lose it faster. So I met with the other surgeon and I told them I wanted to ponder my decision and so I went to work and talked to three people who had had gastric bypass (2) and one person who had the lapband. One of the two people who had the gastric looked sickly and emactiated and the other one was ok. However, she told me she did not "mean to" lose all that weight but she did, the bottom line is that you can't control the weight loss. How much or how fast, and with lap band you can control both so I decided to go that way. I have 200 lbs to lose and that seems to be a challenge on the lapband, but I know it's possible, So that's why I chose to have it...August 16th is my surgery date.

I had my band removed separately from my sleeve (band removed in April and will get sleeve at the end of the month). I don't think it was called a revision but my insurance was billed separately for 2 surgeries. Not sure if that helps you but my understanding is that the insurance companies require all of the same pre-op things (supervised diet, psych, etc.) before approval even if it is all done in one surgery. Edit to say that I also had a different insurance for my band placement in 2007 and my removal and sleeve in 2015. Hope that is helpful. I don't think that they care about this as long as your insurance doesn't have an exclusion. Your surgeon's office will write a history and they will hear about everything and consider it.,

I actually researched for a year before deciding. I researched outcomes and complication rates for both and talked to people I know that have had either VSG or bypass. I decided on sleeve since it doesn't have the malabsorption issues and there are less associated complications and side effects. On my initial visit, the nurse practitioner that works for the program suggested I revisit bypass because I have PCOS and she said my weight loss would be better with bypass because of the malabsorption. (PCOS makes it harder to lose weight). However, I was set against bypass after all my research and when I met with the surgeon, he said I made the right decision especially considering some of the meds I take for asthma and with the fact that I sometimes have to take steroids for my asthma. He says with the malabsorption, my meds would not be as effective. So ultimately, I would say to do some research, decide what you can live with and then discuss it with your surgeon. Sent from my iPhone using the BariatricPal App

What did they have to do for your revision?

I'm in the hospital overnight as we speak after my revision. I had to stay overnight for my 1st surgery as well. Good luck with your revision.

I've recently started adding bananas to my protein drinks because quite frankly, I was getting sick of them and getting nauseus (sp?) when I drank them. I told a friend of mine who had the Gastric Bypass and you would have thought I told her I was putting 5 lbs of plain sugar. She was just in shock that I would do such a thing! Am I doing something wrong? I told myself that it was because we had 2 different surgeries, and that's what made her react the way she did. I thought I'd ask the experts here on the board. Thank you!

I am going to have to get my lab band removed or revised. I am going to choose removed, as they are no longer performing the procedures around here and no one wants to mess with it if I have problems, which I have had tons. I have had mine for almost 10 years and was down to 115lbs. I have since gained 50lbs. While my insurance will pay for the removal, they may not pay for a revision to a sleeve. I have IU health plans for an insurance, and I can add my husbands insurance, which is ANthem premium, if needed. Does anyone know what the rough cost is for a revision to sleeve? What about just the sleeve portion? Anyone had any luck with IU health plans on appeal, as I am sure it will have to be appealed. I feel like I have worked so hard and put up with so much in the past ten years.

Hey. I can tell you straight up that I have heard we have one bay area Dr. who refuses to do follow-up on patients who are not his own. He too is a Lap Band patient. He has a practice in Z-hills and now Brooksville and is with the JourneyLite group. I started my search for a band doctor in 2006 and they were slim to none around here. Town and Country was doing SOME type of bariatrics, I think it was the bypass, but the BAND which is what I was looking for was not popular. I can tell you that Millenium Medical in St. Pete does Fills. It looks not so hot from the outside but once you go inside and go back into their maze of support systems their personnel are nice. My one and only fill was not to the caliber of my own surgeon in Colorado and for that reason I chose to not go back to Millenium and make the investment to the conclusion, to my goal weight, by committing to stick with Dr. Kirshenbaum. I fly to Colorado about every 5 months. I get to see the seasonal changes, snow, mountains and have that trip down to a fine science. I belong to all the flight cheapo clubs and car rental places. I plan on my trip and can usually do the run for $800. Well worth it considering it's my body. So that is how I developed a plan for myself. YOU are worth it. Start thinking that way. Whatever it takes to make it happen, commit to doing this for you. If that means doing a puddle jumper to Miami-Ft. La-Di-Da then do it. Be willing to drive for YOU. Fills only happen about once every four or five months on average, you may find it different. But hey, there are places all over the state. Ocala has a place now, Miami is the hub for bariatrics and bariatric plastic recontouring surgery. These places are so use to folks coming in from out of town they accomidate you especially if you are doing that. Best to you and let me know if you need anything. I'm local. LUCK! Patty

I had the Sleeve in 2015. I have been having issues with acid reflux and muscle cramping in my stomach. I was working on each issue separately but I decided to get an upper GI because I have been considering converting to the bypass to fix the reflux. When they did the GI they saw something they didn't recognize. It looks like a half deflated balloon above my stomach. It could be the thing that is coming out of stomach and causing my pain. Does anyone know what this could be? Fixing my reflux may now be on the back burner. Sent from my LGLS991 using BariatricPal mobile app

OK so I was denied a lap band to sleeve revision by BCBS MN due to no issues (slip, erosion, etc) with my lap band. ???? Have had the lap band for 9 years, did OK at first, then a lot of obstruction issues. Surgeon consultation, EGD, NUT, psych evaluation all completed. My hubby is joining Navy and we will be switching to Tricare in December. What are my chances on getting approved thru them? Will I have to start process all over? #tryingtostaypositive Sent from my SM-G930V using the BariatricPal App

Tricare said I can do an external appeal and are sending me the paperwork to do it. I was in Washington when I got the original surgery done and now in Illinois. My new surgeon has written a letter saying that it was a error and that I will need to have a revision but I still got denied.

Hi all! I am scheduled for Gastric Bypass on August 2nd..in 2 days!!! I just got a a terrifying phone call. Some lady said that she was calling from the hospital where my surgery is scheduled. She said my insurance is covering 80% and I'm responsible for the 20%. (I was already aware of that) Then she said that my 20% comes out to $6,630 and that I had to leave a deposit over the phone of at least half. My surgery center required a deposit to meet my deductible of $3,000. I paid that last week. I told the lady on the phone that I had already paid $3,000, she said it wasn't showing up on her end and that it might've just been the surgeons fee which is not included in the facility fee. I AM FREAKING OUT. I don't have another $3,000 to pay by Tuesday!! I can't call my insurance or surgeons office since they are both closed on Sunday. Has anyone gone through this??? Sent from my iPhone using the BariatricPal App

Hi, I had mine done on November 14th, I used Dr. Marza and he was great. Thanks for the reply. I hope you do great with your revision.

I was self pay for my revision....so my price was more than the typical VSG.....but Dr. Yu has self pay packages as well, his office is very helpful in telling you up front what you will be responsible for before surgery....

Sleep study - I believe why they order them, other than the fact that many severly obese people have sleep apnea (as described above) and can die from it, it's because most insurance companies won't pay unless there are some "co-morbidities" unless your BMI is extreme. I have it, and use a CPAP machine at night - the change was fantastic - I felt so much better with it, since I wasn't having to sleep sitting up and waking up dozens of time a night) So, you need to know if you have it so it can be treated immediately - leads to high blood pressure, stress on heart, and even death. And because it will be helpful information for anesthesia when they put you to sleep. And because it will be another marker of sucess of weight loss, because weight loss may eventually cure it. Pre surgery diet: My bariatric center required 3 month supervised diet in order to see if I could maintain a healthy diet and loose weight (follow the rules). Many insurance companies require it (some 6 mos to a year). If you can't maintein or loose weight before the band by following the diet, you may be a better candidate for gastric bypass, since the gastric bypass doesn't let your body absorb as many nutritients from the food and has more severe consequences if you over eat sweets (dumping syndrome). Another reason for the pre-op diet is to shrink the liver, which makes it easier for the surgeon. The presurgery diet is basically a healthy diet - low fat, high Protein - 60 - 80 grams of protein a day. Plus lthey wanted me to find a Protein shake that I liked because you need them for the first month after surgery until you can tolerate solids better. Some surgeons require a clear liquid diet before surgery for a week or two - mine didn't. I think that's to shrink the liver. PIll size: I break my pills in half and have no problem. I don't have a good restriction. Post op I used liquid paid meds. I have heard capsules can cause problems, but I haven't had any problem. Talk to your phamacist if concerned about med size - often they can be crushed or you can get liquids, but some meds shouldn't be taken out of the capsule or crushed. And by the way, since my surgery in April, I'm now OFF most my meds, so it's not a problem anymore! :-) Hope that helps.