Lap Band to Sleeve -Insurance question????

[Gracie 1]

Just a quick question. Did any of you have to complete the 6 month diet before your insurance would approve your lap band to sleeve procedure? I can't believe they would have consider you to do this. I have the lap band now (2004) and I'm going for a revision to the sleeve. My dr. office just put in my request to my insurance company on Friday, so I'm just sitting on pins and needles wondering what they are going to require...I would think a 7 yr diet plan with the lap band would be sufficient for the 6 moths of tring to lose weight....??? anybody? thanks

[lml32937 65]

Mine did not but I don't know if my extenuating circumstances of worsening auto immune problems helped with that decision or not.. BUT do make sure they get both the removal and sleeve authorized as 2 seperate things... I've heard horror stories on people preparing to do both and are only authorized for the band removal... do double check.. I am lucky to have such good coverage.

[CowgirlJane 14,261]

I did not have this... sounds like a mistake???

[want2bthin 93]

What insurance company do you have? I have United Healthcare and they are requiring this. I think it is absolutely ridiculous and intend on writing an appeal letter. I recently moved so

am waiting on receiving some of my old medical records from my previous state to include with the appeal letter.

My Lapband removal was approved but my revision to sleeve was not - because of not having the six months pre-op diet. Like you, I feel like having a LapBand for the last 5+ years

should qualify as my diet. What's even more ridiculous is that the denial stated that the diet had to be supervised by a doctor who does not perform weight loss surgery. Why would

I go to another Dr. for weight loss when I already had weight loss surgery?

Just to cover all angles though, I found a new Primary Dr. in my new State who will support me for the surgery and started on a plan about 7 weeks ago. He is well versed in

how the process works so he is making sure that he writes in his notes what I am doing and the results.

I hope you don't have the same requirement. I fully understand it for someone who has not had WLS and I went through it before to get my Lapband approved originally; but for revisioners it makes no sense.

I chalk it up to just another stall tactic so I will be appealing even if I'm almost done with the six months by the time the appeal decision comes through.

I hope your insurance or your employer's requirements are more sensible then mine.

Susie

[band2sleeve 1]

I have Security Health Insurance. My revision approval went through in about a week and a half. I didn't have to do ANYTHING! I just had to schedule my surgery and show up. I didn't even have to do a pre-op diet.

Good luck to you. I think it would be crazy of them to make you do another 6 month diet. What a bunch of bull!

Shelli

[want2bthin 93]

Band2Sleeve:

Wow - you are very fortunate. I am almost two months into my pre-op diet and still plan on appealing to try and get the surgery sooner but am waiting on paperwork from my former Primary Dr.

What complications did you have with the band that led up to them approving the revision? My band removal has been approved; but not the revision. All because of not having the six month pre-op diet.

I have reflux and esophagal dialation, plus it slipped up on my esophagus so isn't even on my stomach. Thankfully just having it unfilled completely has made a world of difference in living day to day until I can get this thing out of me - and I definitely do want it out!

Just wondering if you had more serious complications like stomach erosion that led them to approving the revision so quickly. Good for you for having such a great plan and insurer.

Thanks.

[band2sleeve 1]

In the 2 years that I had the band, I had about 30 fills/unfills. A couple of them complete unfills. Most were done under fluro at almost $1000.00 a pop. I think the insurance company was sick of paying for my fills/unfills. We could never find my "sweet spot" I was either too loose and could eat anything and everything and quickly gain weight or, I was too tight and couldn't keep a thing down and had terrible acid reflux. My doctor had been suggesting the revision for about a year. I had to do a lot of research first before I felt comfortable with the revision. On my last unfill, I told him I was ready. He wrote the letter and 1 1/2 weeks later I had the approval and my surgery scheduled. I commented to him that he must be a good letter writer. He just laughed and said I had good insurance. My fear was that we might change insurance providers next year with my work contract. The insurance company they wanted to change to doesn't offer ANY WEIGHT LOSS related coverage. I felt pressured to get something done before that happened. I knew I couln't live with the band at $1000.00 a fill/unfill. I feel so much better with it out. I was sick of being sick at almost every meal and feeling the pain with being stuck all the time. I'm hoping this works out much better. At this point I just don't want to gain back what I have already lost. If I loose the additional 15# to get to goal, that would be a bonus.

I hope this answers your question. Also, my surgeon found a hernia just above my band upon removal. He fixed that and commented that the hernia might have been a factor in my terrible acid reflux. So far, no reflux! YEAH!

Shelli