My story

[Looking Forward 0]

Hey. I have been reading posts on the board for a while now, but decided to write now and get some advice from people who have had this procedure done. I got the lap band about 3 years ago. At first I had pretty good success with it, but then started to have problems and couldn't keep any food down and was throwing up all the time. I went back to the doctor and got some Fluid taken out and an upper GI. The band was too tight and causing some prolapse. I went back for another upper GI and it had gotten better since the doctor took some out but then I could eat more food so he put a little back in. To make a long story short I cannot seem to find that happy medium with my band to be able to loose weight without puking my guts up every time i eat food. Therefore my docotor told me about the sleeve, so I went home and researched it.

I found out that this was something that I could possibly do and be happy with that wasn't as involved as the gastric bypass. I talked to my mom and she was all for it, so we decided to go back to the doctor and tell him we wanted to do it. One problem was that because I am still in school and under my dads insurance i needed to do it this summer while i had a break and before I lost my insurance. Well we submitted to insurance company and they approved removing the band but denied the sleeve. Long story short again it has been a big mess with everything and we did an appeal but they held the original decision. I am at a loss as of now of what to do. I really want and think I need the surgery but I really don't have the money to do this, plus there is a small part of me thats scared to have the surgery so that doesn't help the process. Another problem is that I pretty much have to have the surgery this coming MOnday if I am gonna to do it because I have an externship starting in June and then school starts again.

Reading the posts on this board have given me lots of information and inspiration. I would be grateful for any wisdom or advice. I am so frustrated with all of this and I am starting to gain some weight back which kills me even more. I don't think I can bear to gain back the weight I lost from the band even though it wasn't much about 30/40 pounds.

[MINI-Me 196]

First of all, thanks for telling your story and posting.

As for your surgery ... Any option for the doctor to submit charges for the removal of the lap band to the insurance and you pay for the sleeve portion? That should help some on the cost.

[happyslvr 2]

I was just going to suggest the same thing as Mini Me.

Its worth looking into??

Good Luck and dont give up.

If there is a will there is a way.

[Tiffykins 672]

I would see what the surgeon would charge you privately for just the sleeve. Have your insurance company pay the hospital, the anesthesiologist, and all those fun charges and you pay for the sleeve.

What is the reason your insurance is denying the sleeve portion? Also, would your surgeon be willing to a do a peer to peer review with the insurance company. That is another option. I have tons of appeal information if you would like me to share it, but it may not help any.

Also, there are some amazing revision surgeons out there that accept self-pay patients. I know money is difficult to come by, but if you can get a low interest loan, or your parents help with the cost, I think it's an amazing surgery. I had a band, and before it does any real damage to your stomach tissue like it did mine, I hope you are able to get it out.

As for any follow up care you would need, like lab work, and weigh ins, you could always have your PCP pull your labs, and you could send them to your surgeon if he would be willing to let you pay for the sleeve alone.

Your PCP would not have to code the labs being needed for weight loss surgery. It could just be for follow ups especially if you have co-morbidities.

I'll keep you in my thoughts, I know how frustrating the band situation can be.

[lmmore 0]

Appeal. If you have a good doctor, he should be able to write up a statement that convincingly shows you need to have this done. They are good at that stuff. You have nothing to lose.

[Looking Forward 0]

Thanks for all of the input. I don't really know why the insurance company won't pay for the surgery, they say its not medically necessary. I could appeal again but I am running out of time to be able to do the procedure and have enough recovery time. My option right now that I am looking into is to pay for the sleeve and get the insurance company to pay for the removal. I am now looking into the costs of doing this, so I guess we will see what happens.

Does any happen to know if at all possible, if I go ahead and do the surgery and then keep trying to get the insurance to pay for the sleeve. I don't know if this is even a possibility that when I have the surgery if my doctor can document that the band was causing problems so that the insurance company will then pay. Just curious if any one knows if they would even consider that.

Thanks for the input and encouragment. I will let everyone know what happens. I really want to do this surgery because i think it is best even though I am scared of actually doing the procedure. I have this nagging feeling that I have to get this band out of my body!

[MINI-Me 196]

You can always appeal after the fact - just be prepared to pay if they deny. In fact, your surgeon may require the cost of the sleeve upfront since you are currently denied, but who knows. It never hurts to ask ...

[sam30204 0]

First of all, thanks for telling your story and posting.

As for your surgery ... Any option for the doctor to submit charges for the removal of the lap band to the insurance and you pay for the sleeve portion? That should help some on the cost.

Although it would be great if insurances would let this work but they don't. The problem with this is it wouldn't really cut down on her expense for the sleeve at all. See the way the OR's bill is in time increments (most are per 15 minutes)

so basically as soon as the band is out, the billing would start over for the sleeve. I mean the doc may discount his fees a but but the hospital generally does not. I tried this with an necessary surgery with an elective one once.