Newbie with a question

msbug · September 18, 2010

Hi all. I was banded in Aug '06 and just found out my band needs to come out. I feel like I have very little restriction, however I have horrible reflux and am waking up vomitting at night. Gross. The upper gi showed the band is very tight, which my surgeon says makes no sense since I don't feel restriction. He's going to submit to insurance, saying it's medically neccesary to remove the band and to convert to sleeve. I'm just hoping they approve it! I have Anthem Blue Cross. I was self pay for the original band surgery though.

Did your insurance pay for any of the surgery? Either removing the band or the conversion? If they paid for the removal but not the sleeve, how much was the sleeve part?

Thanks for sharing your stories! I've been pouring over these boards since I found out I might have to get the band out. The sleeve really appeals to me. Hopefully I'll be able to finally get to goal! I lost 75 pounds with the band, but to get to my "ideal" weight (according to the weight charts) I need to lose at least 70 more. My BMI is still 35.

mila1013 · September 18, 2010

Hi all. I was banded in Aug '06 and just found out my band needs to come out. I feel like I have very little restriction, however I have horrible reflux and am waking up vomitting at night. Gross. The upper gi showed the band is very tight, which my surgeon says makes no sense since I don't feel restriction. He's going to submit to insurance, saying it's medically neccesary to remove the band and to convert to sleeve. I'm just hoping they approve it! I have Anthem Blue Cross. I was self pay for the original band surgery though.
Did your insurance pay for any of the surgery? Either removing the band or the conversion? If they paid for the removal but not the sleeve, how much was the sleeve part?

Thanks for sharing your stories! I've been pouring over these boards since I found out I might have to get the band out. The sleeve really appeals to me. Hopefully I'll be able to finally get to goal! I lost 75 pounds with the band, but to get to my "ideal" weight (according to the weight charts) I need to lose at least 70 more. My BMI is still 35.

i am sure that if you "have no restriction" and you have horrible reflux you have megaesophogus and potentially dysmotility. what did the barium swallow state about your anatomy? was your surgeon present at the swallow? you should have your band completley deflated immediately as to not cause more esopohogeal complications. it is obvious that your band is too tight and your esophagus will pay the price. depending on what is going on in your anatomy -you will need a barium swallow and endosocope to prove this, for the insurance co. band removal is considered a "medical emergency" and pre approval is not necessary. now converting to a sleeve that is a different story that is a pre cert requirement. depending on your insurance policy they will deny the sleeve as investigational, appeal it always....good luck

Mila