Eroded band to sleeve - I won my appeal!

[FXDF2008 14]

For those who haven't been following my story...............

I was diagnosed with an eroded band in November of 2011 and had it removed in March of 2012. I had to wait for six months before revising to the gastric sleeve as my surgeon wanted to wait for me to heal completely and do medical tests before confirming that I would be a good candidate for the sleeve. I have complete those tests and he was satisfied that I could have the sleeve. We also found that I had developed another hiatal hernia (the first one was repaired when I had my lap band surgery).

My predetermination request for the sleeve surgery was denied. They stated that I needed to complete a six month weight loss program in order for them to consider my request. I asked my surgeon's insurance coordinator to appeal based on the reasoning that this was a repeat surgery for a lap band that had medically failed me and that I shouldn't have to complete the six month medically supervised weight loss program. She filed an appeal but no where in the letter did it address the six month weight loss program so of course they denied me again stating that we still hadn't submitted the records they had requested.

Frustrated beyond belief, I took the initiative to write my own appeal letter. I used language from the BCBS-AL bariatric policy regarding repeat surgeries and their rationale for requiring the six month weight loss program and explained how I had met that rationale just by having a lap band for four years and that my waiting for six months before revising to another surgery was not conducive to improving my health.

I just got off the phone with BCBS-AL and they have approved my surgery!!!!!! I am actually shocked that I succeeded in my appeal. I fully expected them to deny me and had already started the medically supervised six month weight loss program in preparation for that denial (and have lost 10 lbs over a six week period which is nice).

I'm excited, relieved and nervous! I've been through this before so I don't know why but I am. I was very successful with my lap band (losing 94 lbs). I remember how wonderful it felt to be thin and feel good about myself and how I looked and not to be in pain anymore from carrying around all this extra weight (yes I packed the pounds back on after my band was removed). I can't wait to be there again!

Yeah me!!!!!!!!!!!!!!!!

[brandibandtosleeve2012 12]

Congrats on your win! My insurance initially denied the revision but we submitted it again after waiting a year and they approved it! I'm so excited! I wish you the best on this new journey.

[gloriann 43]

Congrats!!! Good luck and keep us posted.

[FXDF2008 14]

You know? It feels like I've been riding on a roller coaster. For the past year I've been battling surgeon's offices and insurance coordinators in order to get approval for my revision to the sleeve after my band eroded. It has been like being at the start of the roller coaster where you are slowly but surely grinding your way up the initial peak.

Well I just reached the top of that peak and now feel like I am going 100 mph down the other side of that peak!

My surgery has been scheduled for January 10th! I begin my pre-op diet tomorrow and go for my EKG and labs next Wednesday.

Holy crap!!!!!!!!!!!!!!!

[FXDF2008 14]

Well tomorrow is almost here! I can't believe how quickly the time has flown by. My doctor expects for me to be in the hospital for two days. He expects the surgery to last for about two hours with one to two hours in recovery. I have to be there at 5:30 a.m., surgery with be at 7:30 a.m.

Here we go folks!

[genepha 47]

Congrats on your appeal and good luck with your surgery and recovery!

[Bandit 0]

Hi my name is Nina and find your story very interesting. I too have had issues with my insurance company especially since I've had this miserable band since 2006. I have lost very little weight. Also am so tired of the acid reflux, constant vomiting, not eating and never losing weight even though I only consume between 700 to 1200 calories. Having had the band for almost 7 years I have little result since I had high expectations. It has been such a let down having an object in my body that hasn't helped me lose very little weight. I've had the dry heaving 3 times and ended up in the ER. I would like to have the sleeve, but insurance company wants a supervised 6 month diet. Seriously, having the band 7 years should be proof enough that I've obviously tried and what more do I need to prove. My only question to you is would you mind sending me your letter (without your personal info of course) as a template to send to my insurance agency? I just need an idea on how or what to say so that I can appeal it. I just want this foreign objectout of my stomach. And I want something that works.

Nina