Shoot me now - I just can't win

[Lynn B 0]

I just got a call from my surgeon's insurance girl "Congrats, you were approved" - Yaaaaaaaaa - "They are going to replace your band with a new one" - HUH???? WHAT???? OK - I spoke with the surgeon about band to sleeve revision - WTF??

Then she proceeds to blame me because I emailed the office and my email said band revision so that is what she submitted me for - DUH - my email and I quote was "Band to Sleeve Revision" and since when does she use a patients email as the basis for her insurance approval??? The surgeon had to write a letter - he knew what I wanted - I just don't understand how these things get screwed up. So she has to do it all again - only took three weeks - do you think it will be faster this time??

I have a tentative surgery date of 9/7/10 - 5 days before my 5 year band anniversary - If I don't go mental by then.

[Tiffykins 672]

Awwwww Lynn, that sucks, and I'll keep my fingers crossed that the process goes faster this time. I'm sitting here shaking my head in disbelief.

[Lynn B 0]

Thanks - I'm sure it will be fine but I would really just like an answer so that I can start planning time off and stuff. Grrrrrrr Thanks for letting me vent.

[breezy 8]

Vent all you want! It's nice to have some place where you can let off steam. And not everything can be honey and roses. And this is one of them. Grrrrr.... That sucks!

[MINI-Me 196]

How can such competent and great surgeons have such incompetent people working for them? It drives me CRAZY!!!!!!

Sorry that you are going through all of this. Since they've already reviewed your case, it should be faster this time. Do you have the name of your case worker at your insurance company? If so, once the paperwork is submitted, you may want to give them a call - sometimes a call will magically make your paperwork go to the top of the stack. Good luck!

[pattimomof3nj 21]

Hey that is almost as good as mine! My surgery for my band removal on July 8th was approved! YAY! but the revision to the sleeve DENIED! HUH! it was supposed to all be at the same time, the reason, my BMI is not over 40! WTF? I've had a band for 2+ years and it WAS working until October, so of course my BMI is not over 40, DUH!!! the Insurance girl is sending in an appeal, other than that, I guess I will be paying out of my pocket (ass) for the sleeve!

Patti

[Lynn B 0]

Patti - I have cigna and the requirements for revision/reoperation are different from those of a virgin surgery.

Reoperation and Repeat Bariatric Surgery:

Page 2 of 40

Coverage Policy Number: 0051

CIGNA covers surgical reversal (i.e., takedown) of bariatric surgery as medically necessary when the individual develops complications from the original surgery such as stricture or obstruction.

CIGNA covers revision of a previous bariatric surgical procedure or conversion to another medically necessary procedure due to inadequate weight loss as medically necessary when ALL of the following are met:

? Coverage for bariatric surgery is available under the individual?s current health benefit plan.

? There is evidence of full compliance with the previously prescribed postoperative dietary and exercise program.

? Due to a technical failure of the original bariatric surgical procedure (e.g., pouch dilatation) documented on either upper gastrointestinal (UGI) series or esophagogastroduodenoscopy (EGD), the individual has failed to achieve adequate weight loss, which is defined as failure to lose at least 50% of excess body weight or failure to achieve body weight to within 30% of ideal body weight at least two years following the original surgery.

? The requested procedure is a regularly covered bariatric surgery (see above for specific procedures).

NOTE: Inadequate weight loss due to individual noncompliance with postoperative nutrition and exercise recommendations is not a medically necessary indication for revision or conversion surgery and is not covered by CIGNA.

I have lost over 50% of my excess weight but I'm no where near 30% of a normal BMI (and I've put on 15lbs since they took the Fluid out of my band). I'm hoping where they approved me for a new band that the sleeve wont be a problem because it is a "regularly covered bariatric surgery" per their list.

I hope get your people fixed and we can both be sleeved!! Good luck

[deletedsally 8]

I'm so sorry your surgeon's office got things confused! Hopefully they will get it the new approval soon!

[Ellisa 6]

Hey Lynn,

Any news yet? Hope they come through for you.

[Lynn B 0]

Nope - trying to be patient - I'll give them till thursday and then I'm on the phone - thanks!

[pattimomof3nj 21]

Oh Lynne, you are lucky! My surgeon is having a peer to peer tomorrow with my insurance company. Hopefully they can work something out, i'm even willing to pay the difference of the band removal (approved) and ulcer fix (approved) and the cost of the sleeve. I just want this broken piece of shit out of me. It is now starting to cause problems when I am stressed, which is 90% of the time, thanks work. I cannot even get my Protein shakes down. I'm just going to keep my fingers and legs and toes and yeys crossed and hope for the best! for both of us that they can resolve our issues soon!!!

Patti

[Lynn B 0]

Patti - that is a bummer - I've got all my pieces parts crossed for you to!!

[Papillon 7]

I hope everything comes through soon for both of you!!... sorry to hear you have had such a time of it. : (