Out With Lap Band, In With Sleeve...but Insurance Denied!!

[CherBee 1]

So the WLC just called and said my insurance denied the whole procedure until I go thought the WHOLE pre-op procedures that I had in 2005, including nutrition, psych, etc. I had a required sleep apnea test done which qualified me this time around since I was just under a BMI of 40. I thought that was all I needed. And now this. I have the surgery already scheduled for Sept. 24 with a one night stay to remove the crappy Lap Band and have the Gastric Sleeve done. I am pissed. I am waiting to hear from the insurance coordinator from the WLC. I asked can I get the band out and later get the sleeve after all ducks are in friggin' row and have it all covered? I think insurance companies are cracking down on these procedures, even tho they have proven to be more cost effective than treating ailments caused by obesity. Anyone else in a similar situation? I probably won't have anything done w/o the insurance coverage.

[DELETE THIS ACCOUNT! 12,703]

It makes sense you'd have to go through all the pre-op procedures again. 2005 was 7 years ago, a lot can and likely has changed since then. I say just do what they ask and get it over with so you can get your surgery.

Why are you having your band removed?

[CherBee 1]

The most weight I lost with the band was pre-band and 2 months post band. The the weight started coming back on. It made me gag, puke, and the band itself shows on the outside. At one point the port turned and was difficult to fill. The main thing...my appretite was not suppressed. My stomach never felt full...just me gullet to the point of drooling. I have the original band whatever it was called, not the newer version. I have spoke to people who had the band and have had the GS revision and all are pleased.

I guess I will have to play the waiting game. But going back to square one just makes no sense to me.

[Jean McMillan 2,973]

I had to go through a lot of the pre-op stuff again in honor of losing my band and gaining my sleeve. I have a friend who's having to go through ALL the pre-op stuff again in preparation for converting to RNY. If those are the rules of the game, those are the rules you've got to play by. It's frustrating but by no means lethal.

[Jean McMillan 2,973]

I have spoke to people who had the band and have had the GS revision and all are pleased.

Be aware that former bandsters who convert to the sleeve may be delighted with their sleeve mainly because their band was so troublesome, not because the sleeve isn't troublesome.

I lost my band in April and had sleeve surgery in August. The good news is that I've lost 12 lbs since then. The bad news is that my physical hunger (which supposedly disappears because of reduced grehlin production) is fierce. I can eat only a few bites of solid food at a time and get ravenously hungry an hour later. It's a pain when I'm at home, but a real problem when I'm at work and am not allowed to eat or drink except when I'm on my 15-minute break, during which time it's almost impossible to eat a sustaining amount of food. The other bad news is that I experience dumping if I overeat, eat too fast, or eat anything with more than 5 or so grams of sugar in it. You'd be astonished at how much sugar some "healthy" foods contain, like skim milk with 12.4 grams per 8 oz serving. I had been told that VSG patients don't dump because the pyloric valve is preserved (unlike RNY), but my surgeon says it can happen because my tiny new stomach can't store or churn food for very long, so it dumps the food into my intestines fast enough to make me hot, sweaty, dizzy, and very nauseated.

I hope that none of that will happen to you, but beware of the rosy picture some ex-bandsters paint about the sleeve. Results not typical, you know....

[kbklassykimb 23]

Be aware that former bandsters who convert to the sleeve may be delighted with their sleeve mainly because their band was so troublesome, not because the sleeve isn't troublesome.

I lost my band in April and had sleeve surgery in August. The good news is that I've lost 12 lbs since then. The bad news is that my physical hunger (which supposedly disappears because of reduced grehlin production) is fierce. I can eat only a few bites of solid food at a time and get ravenously hungry an hour later. It's a pain when I'm at home, but a real problem when I'm at work and am not allowed to eat or drink except when I'm on my 15-minute break, during which time it's almost impossible to eat a sustaining amount of food. The other bad news is that I experience dumping if I overeat, eat too fast, or eat anything with more than 5 or so grams of sugar in it. You'd be astonished at how much sugar some "healthy" foods contain, like skim milk with 12.4 grams per 8 oz serving. I had been told that VSG patients don't dump because the pyloric valve is preserved (unlike RNY), but my surgeon says it can happen because my tiny new stomach can't store or churn food for very long, so it dumps the food into my intestines fast enough to make me hot, sweaty, dizzy, and very nauseated.

I hope that none of that will happen to you, but beware of the rosy picture some ex-bandsters paint about the sleeve. Results not typical, you know....

Thank you for posting some of the negatives of converting to the sleeve, I never see any of them. I was debating, but I think I will keep my band.

[CherBee 1]

Thank you everyone for your prompt replies. One of the things that is really bugging me is that the insurance denial came through so close to the procedure...2 weeks. I'm not sure who to blame, if anyone, on this. I amstill waiting to hear back from the WLC on my insurance. i have not contacted the insurance people myself yet. Oh,and today in the mail i get a claim form from the insurance co. that my visit at the WLC is not covered from Aug. 12 and it's for $145. A 15 minute long office visit! At this point I am hoping to get the band out on Sept. 24 and the sleeve done in early March. But in the meantime, i am on my own with dieting. And as I said before, i can't move forward on anything, not even another drs. appt. till I get this insurance thing figured out. i am also going to talk to more sleeve patients at the next WLC meeting. I have heard nothing but positive feedback so far.

[Jean McMillan 2,973]

Thank you for posting some of the negatives of converting to the sleeve, I never see any of them. I was debating, but I think I will keep my band.

I'm probably not being very objective about the sleeve right now. I think it could be an option for someone who wants to revise because their band was so problematic, but if you're thinking of revising because of disappointing weight loss, I'm not sure you'd be all that much better off.

[chatty826 4]

I did mine in two procedures

Just had band out and heard that I have to wait till end of November to recheck and see about getting bypass done. This according to my doctor to allow for healing.

Good luck with your process and yor insurance company.

[chatty826 4]

Just had my band removed two weeks ago and I have to wait till november to consider the revision to bypass. Sucks to wait but I trust my doctor.

[jrae 38]

Thank you so much for the honest feedback on your sleeve Jean! You never hear much about complications. My band & I have had a rough time these 3 years! My weight loss was never easy. I'd been doing so much better but lately have had bad heartburn & have been waking up choking on stomach acid! Awful stuff. My surgeon talked to me about converting to the sleeve but I'm afraid. If I failed with the band I'll probably fail with the sleeve.

[elcee 3,340]

Thanks Jean. It is refreshing to hear an honest opinion of life with a sleeve. All we usually get is the sparkly,shiny, perfect picture. The only reason I know that it isn't quite so rosy is because I keep going onto the VSG board and reading their complications forum. Any time I think maybe life would be easier on the other side that straightens me out!

[Jean McMillan 2,973]

Thank you so much for the honest feedback on your sleeve Jean! You never hear much about complications. My band & I have had a rough time these 3 years! My weight loss was never easy. I'd been doing so much better but lately have had bad heartburn & have been waking up choking on stomach acid! Awful stuff. My surgeon talked to me about converting to the sleeve but I'm afraid. If I failed with the band I'll probably fail with the sleeve.

Another thing to keep in mind about the sleeve: reflux is very common in sleeve patients, so that they have to take PPI's, at least in the first few months, if not forever.

Please don't tolerate the reflux you already have. I've learned the hard way that it can do a lot of damage to the esophagus that (if the damage is bad enough) can lead to a pre-cancerous condition called Barrett's esophagus and/or require a difficult surgery to improve esophageal function.

[elcee 3,340]

Yes that is something I have never understood. If your band is causing reflux how does converting to a sleeve help if reflux with a sleeve is so common?

[SoccerMomma73 1,867]

Yes that is something I have never understood. If your band is causing reflux how does converting to a sleeve help if reflux with a sleeve is so common?

I've wondered the same.....