What do I do now???? Help Please!!!!

[STARLIGHT 0]

ok here is my story......I had lap-band surgery in July 2008 and I lost about 75 pounds, granted I was throwing up most of my food that I ate, so I am sure that’s why I lost the weight. In my mind throwing up and losing weight and having a little bit of port pain and side pain was outweighing not having to take blood pressure meds and having sleep apnea and getting heart disease, (which runs in my family) so I just dealt with it up until March of 2011 when I got to the point where I could not get any food or Water down without it coming right back up and I starting having really bad reflux and pain in my stomach and port area. I had to go to the Dr. and he removed all my Fluid to see if it would resolve the problem and let my band reposition itself and give my stomach time to heal from all the vomiting and inflammation. Over the next several weeks I was able to eat and not vomit every time I ate, but I would still get nauseated and the pain would still be there, not bad like it was before the unfill but still there. Not to mention I started GAINING MY WEIGHT BACK. In May 2011 I went back and the Dr. started to try to refill my band starting out with a small amount of fluid, at first it seemed to be ok but after a week or so the pain and vomiting came back full force which just happened to be on a weekend and I tried calling my local emergency rooms and get them to take out the fluid and they said that they would not touch me I would have to go and see my Dr. So the first thing that Monday morning I called the Dr.‘s office and they told me to come in and they would remove the fluid. Once again it was like relief. Of course I am still having stomach pain and port pain after eating and nausea, vomiting and reflux. I have talked it over with my Dr. and he decided that my band was malfunctioning and causing all the pain and problems that I am having and that he could go in and reposition it but the likely of it happing again was great, or I could revise to the sleeve or the bypass but it would be my choice so I decided after weighing all the options that my life and health would be better off with the sleeve. So I gave the ok for the Dr.’s office to proceed with the paper work for a revision due to the band malfunctioning and all the complications that I was having. I cannot live with this kind of PAIN and VOMITING ,not being able to eat, health ,and gaining all my weight back that I have lost, and all the co-morbid health related issues reoccurring again. I had read my INS policy and it states that it will approve and cover a revision for compilations related to the first surgery which was the lap-band. I received a denial letter from United Health Care’s Coordination department stating that I did not meet the BMI to have the surgery and that this did not have anything to do with my band.

Have they lost their mind or what??? what do I need to do now.....any help would be great.

[Tiffykins 672]

Have your surgeon submit for medical reasonings? I also know one lady that went into the ER complaining of excruciating pain, vomiting, and she was admitted and had emergency band removal with VSG done at the same time because it was medically necessary. She was only 20lbs from goal with her band, but had been dealing with all the band issues and living on Ensure and Protein drinks.

Her insurance covered it 100%. . Also, your surgeon can request a peer to peer review and get it approved. Have you had an upper GI performed to rule out a slip or possible erosion???? You've got all the classic symptoms of both. Your surgeon is going to have to make your case, and give a medical reason/cause for your problems i.e. a slip, erosion, or other band malfunction.

[Wheetsin 714]

So the first thing that Monday morning I called the Dr.‘s office and they told me to come in and they would remove the Fluid. Once again it was like relief. Of course I am still having stomach pain and port pain after eating and nausea, vomiting and reflux. I have talked it over with my Dr. and he decided that my band was malfunctioning and causing all the pain and problems that I am having and that he could go in and reposition it but the likely of it happing again was great, or I could revise to the sleeve or the bypass but it would be my choice so I decided after weighing all the options that my life and health would be better off with the sleeve. So I gave the ok for the Dr.’s office to proceed with the paper work for a revision due to the band malfunctioning and all the complications that I was having. I cannot live with this kind of PAIN and VOMITING ,not being able to eat, health ,and gaining all my weight back that I have lost, and all the co-morbid health related issues reoccurring again. I had read my INS policy and it states that it will approve and cover a revision for compilations related to the first surgery which was the lap-band. I received a denial letter from United Health Care’s Coordination department stating that I did not meet the BMI to have the surgery and that this did not have anything to do with my band.

Have they lost their mind or what??? what do I need to do now.....any help would be great.

I'm seeing two needs. One is the immediate need of living with the band until something can be done. Two is your insurance.

You sound either slipped, or way too tight to me. I have a hard time focusing on "wall of text" posts (no offense) -- so I may have missed it -- but do you currently have fill or are you unfilled? If you have fill, get it taken out.

Are you actually vomiting (are you purging the contents of your stomach) or are you "PBing" or bringing up the stuck band stuff (saliva, perhaps a few bits of food, foam, etc.)? Vomiting and PBing are two completely different things, and it's important to know which you're actually experiencing.

In either case, if you're truly bringing up either vomit or "stuck band stuff" routinely, then you're also swollen routinely, and that will be exacerbated by more eating, yakking, vicious cycle ad infinitum. I personally would suggest you go on liquids for a week, or better - two. Give yourself a chance to recover, unswell (is there a term for that?), etc. Then gradually work your way through mushies and on to solids over the course of a few more days, and see if that helps. If your band is toast, it's toast -- but a "back to basics" routine can do wonders to make things more tolerable.

Did your surgeon order an EGD, or at least an xray or fluoroscopy or anything to diagnose what's happening? Your band isn't actually malfunctioning, I don't think (e.g.it sounds like Fluid makes its way to the band, and the band is doing its job of restricting) so something else is happening and you need to figure out what. MOST (all that I know of, but there may be an exception) insurance companies will require medical evidence of a slip or erosion to approve removal/revision. You can't just tell them it's not working, and neither can your surgeon, and have that be enough. They won't "take someone's word" so to speak. My insurance company required an EGD as proof - even the xray showing it in the wrong position was not enough, nor was a 2+ year history of documented onset of reflux related to the band. It doesn't sound like your surgeon's office submitted anything like that (because it doesn't sound like they had anything to submit). Find out what your insurance company requires as proof of medical need, and then schedule it with your surgeon. Better yet, ask your surgeon's office why they didn't do it to begin with, and then inform them that they will be doing it. Until you meet their requirements, you will be denied. It will be the same as asking them, "Please? I really want it."

Meeting the BMI of the surgery sounds like a miscommunication. There is no BMI requirement for removal, and I would doubt there's one for revision IF revision is done for reason of medical necessity (unless excluded). I'm thinking there's a chance that, since (apparently) no proof of medical need was documented/submitted, your request may have been interpretted as a voluntary removal, and "medically necessary" second procedure -- which will be treated as an initial procedure (at best), and for which standard requirements most likely apply.

HTH, and let us know what you find out.

[kekerene 35]

I had the same issues with my band and lived miserably for 5 years with it. I had a revision in Mexico with Dr. Aceves 06/23/11 and I feel great. The sleeve is so much different/better than the band. If you hit a wall with your insurance you may want to consider having a revision in Mexico as the prcing is way more affordable than the US. I was a cash pay patient for both surgeries so when I found out my band slipped and had to come out, I went with the cheaper option. Not to mention that Dr. Aceves had a ton more experience with band to sleeve revisions than my Lap Band surgeon did. Hope all goes well for you, please keep us posted

[STARLIGHT 0]

I'm seeing two needs. One is the immediate need of living with the band until something can be done. Two is your insurance.

You sound either slipped, or way too tight to me. I have a hard time focusing on "wall of text" posts (no offense) -- so I may have missed it -- but do you currently have fill or are you unfilled? If you have fill, get it taken out.

Are you actually vomiting (are you purging the contents of your stomach) or are you "PBing" or bringing up the stuck band stuff (saliva, perhaps a few bits of food, foam, etc.)? Vomiting and PBing are two completely different things, and it's important to know which you're actually experiencing.

In either case, if you're truly bringing up either vomit or "stuck band stuff" routinely, then you're also swollen routinely, and that will be exacerbated by more eating, yakking, vicious cycle ad infinitum. I personally would suggest you go on liquids for a week, or better - two. Give yourself a chance to recover, unswell (is there a term for that?), etc. Then gradually work your way through mushies and on to solids over the course of a few more days, and see if that helps. If your band is toast, it's toast -- but a "back to basics" routine can do wonders to make things more tolerable.

Did your surgeon order an EGD, or at least an xray or fluoroscopy or anything to diagnose what's happening? Your band isn't actually malfunctioning, I don't think (e.g.it sounds like Fluid makes its way to the band, and the band is doing its job of restricting) so something else is happening and you need to figure out what. MOST (all that I know of, but there may be an exception) insurance companies will require medical evidence of a slip or erosion to approve removal/revision. You can't just tell them it's not working, and neither can your surgeon, and have that be enough. They won't "take someone's word" so to speak. My insurance company required an EGD as proof - even the xray showing it in the wrong position was not enough, nor was a 2+ year history of documented onset of reflux related to the band. It doesn't sound like your surgeon's office submitted anything like that (because it doesn't sound like they had anything to submit). Find out what your insurance company requires as proof of medical need, and then schedule it with your surgeon. Better yet, ask your surgeon's office why they didn't do it to begin with, and then inform them that they will be doing it. Until you meet their requirements, you will be denied. It will be the same as asking them, "Please? I really want it."

Meeting the BMI of the surgery sounds like a miscommunication. There is no BMI requirement for removal, and I would doubt there's one for revision IF revision is done for reason of medical necessity (unless excluded). I'm thinking there's a chance that, since (apparently) no proof of medical need was documented/submitted, your request may have been interpretted as a voluntary removal, and "medically necessary" second procedure -- which will be treated as an initial procedure (at best), and for which standard requirements most likely apply.

HTH, and let us know what you find out.

I have no Fluid in my band and have not had any since mid may. I have had a all the gallbladder tests that I could possibley have the dr thought that was what was wrong but nope everything was fine and I also had EGD and Dr. says that everything looks fine from that stand point. He thinks that I have scar tissue grown over my band and under my band around my stomach which is causing all the pain. The only way he would know for sure it to go in and look and remove the band I didnt want to have to have surgery just to take a look I want them to be able to do the sleeve not just take out the band and leave me with nothing.

[blondie1007 51]

That my friend is an erosion. I know because I had the same thing a year ago and my band had to come out. My doctor would not immediately do the sleeve so that my stomach would have time to heal (less complications and no leaks)

[STARLIGHT 0]

That my friend is an erosion. I know because I had the same thing a year ago and my band had to come out. My doctor would not immediately do the sleeve so that my stomach would have time to heal (less complications and no leaks)

I have a EDG done and Dr said that everything was fine and looked normal.....I am just so sick of this band. The INS denied me and the appeal cause my BMI was not 35 or above it was only 33 and my band was not the problem....(how crazy is that)....so the next thing I am going to try along with the ins lady at Dr office is now that I have gained some weight back and my BMI is at 38 and sleep apna is back and blood pressure is doing up again we are going to resmit with different reasons from having revision and see what that gets me.....I just dont understand how INS thinks that its healty to go back to the way you were before with all problems before they will do it again...going back to the Dr Thrus or Fri to re-weigh so it will be documented.....and then the waiting process starts again.....I am just so lucky to have such great husband to stand behind me makes it alittle easier.

[NJMOMof2 17]

MY opinion is get the darned thing out!! I know first hand the horrible pain you are in. Get it out, let your tummy heal.

If you really are intent on having both done, file an appeal. Insurance companies love denying the first time. Good Luck. It breaks my heart to read about the band horror stories. Should be taken off the market!