Sleeve After Failed Band..insurance Will Only Approve Another Band!

[kimmybert 0]

I had my band for 5 years and did great...lost 120lbs. It did slip and I had to have it removed in Oct of 2011. I have new insurance and they will only cover another band since that is what I had the first time but I desperatly want the sleeve! Does anyone know if insurance will pay for the band and I pay the difference to get the sleeve?? probably a silly question and I should be happy insurance will pay for another band...I was self pay the first time. I have BCBS of TX. Please let me know if anyone had done this before!! Thanks!

[fattymcfatterson 107]

That is so ridiculous! Insurance is crazy!!! First of all, I would get what the policy is in writing. From the insurance company and from HR. There are many people who have had the sleeve on bcBStx so maybe someone is not understanding? I called my insurance five different times and got five different responses so I finally got it all in writing. Did the surgeon submit the paperwork or did you call? Did you actually give them the procedure code? If there is a written exclusion, get it in writing and then be ready to appeal. Don't give up!

[kimmybert 0]

Thank you...my doctor did submit it and I did talk to the insurance myself. They won't qualify the sleeve because it's like a whole new procedure that I don't qualify for and they will only do the band since I am a revision and that is what I had before. My BMI is only 30 but I am slowly gaining since my removal! So I was hoping to have them pay for the band and just self pay the difference to get a sleeve but I'm afraid they won't go for that! Was just wondering if anyone else got away with that!! Lol