Revision band to sleeve Is prolapsed lap band enough reason to waive 6 month medically supervised diet?

[ribearty 544]

Hi everyone,

First off, I apologize if this question has been asked and answered previously. I did a search and did not find one that matched my question. I was not sure of the forum to post this question between revisions or insurance.

I currently have a lap band in and found out it has prolapsed. My insurance company (UHC) does cover revision surgery. I have met their criteria as far as BMI, comorbodity and psych evaluation. They also have a 6 month medically supervised diet criteria. Has anyone with UHC been able to have this criteria waived with an early submission of a device failure?

Thank you for your replies.

[ribearty 544]

I can answer my own question. The answer is yes. I received verbal approval from the coordinator that the insurance company waived the 6 month diet criteria based on device failure and band intolerance.

[band2sleevesatx 0]

I just saw this and was going to tell you no, you will not have to go thru the 6 month waiting period since you have already had the surgery and are having complications.

[Kristina J. 581]

Glad to hear it was waived. Prolapse was a big issue for me and the issue that led to my revision. Once you've prolapsed once, it tends to happen again and again! Trust me, I would know! lol Congratulations on your approval!!

[Bkhuffman292 1]

Is prolapsed "slipped" - I'm slipped and have all kinds of icky side effects - lots of indigestion, burping, pain in left shoulder/back area, pain in port/stomach like a sharp pulling. My new doctor confirmed the slip - took me 4 months to get the appointment/money copay for fluoro and now I'm told I may have the 6 month "hurdles" to jump before getting fixed. Or just take the band out and do the 6 criteria for the sleeve. Seems ridiculous if they are already inside and I'm okay to have it, why put a person in the hospital twice, twice to sleep, to be cut, so much more expensive - IF THE INSIDES are okay to take out the band and do the sleeve. I'm rambling - Frustrated, Fatter, in FL. Thanks for listening - Karen

[ribearty 544]

Is prolapsed "slipped" - I'm slipped and have all kinds of icky side effects - lots of indigestion, burping, pain in left shoulder/back area, pain in port/stomach like a sharp pulling. My new doctor confirmed the slip - took me 4 months to get the appointment/money copay for fluoro and now I'm told I may have the 6 month "hurdles" to jump before getting fixed. Or just take the band out and do the 6 criteria for the sleeve. Seems ridiculous if they are already inside and I'm okay to have it, why put a person in the hospital twice, twice to sleep, to be cut, so much more expensive - IF THE INSIDES are okay to take out the band and do the sleeve. I'm rambling - Frustrated, Fatter, in FL. Thanks for listening - Karen

Karen,

Can your doctor submit your claim to the insurance company as a failed device? My doctor ran a couple of tests to see if the prolapse was effecting my esophagus. The results came back positive. Based on this information he submitted the claim early to the insurance company. My case was reviewed and approved due to these complications waiving the six month medically supervised diet.

If you don't try, you won't know. Good luck. If you have to wait the six months use that time to examine eating patterns and learn techniques to help you avoid food traps you have fallen into in the past. It also gives you time to stock up on Protein and items you will need immediately after surgery and also possibly for your pre-op diet if you doctor requires one.

[Bkhuffman292 1]

I don'tnow how/what the insurance is doing yet. I'm meeting with the PA and the insurance coordinator on Monday. I don't think with my first couple visit I conveyed how badly my belly felt. I also feel very bloated - and like the rest of my body is retaining Fluid. I'm really just a big fat hot mess right now. I pray they'll get me done, approved quickly. In the mean time I'm starting a great "shake" diet - I can't eat it just hurts. I've been up since 3am from yesterday - sadly enough I had a great day - ate well, then I ate a cheeseburger and fries and paid for it all night. No restriction, no barriers the "fat" person in me comes out full throttle. I just can't thou. I have some gross GNC Lean shakes to get me through a couple days and i'm ordering Vi shakes online - they're awesome tasting and low fat, high Fiber, Protein and 2 shakes equals Vitamins for the day. GOD I pray this goes well. Sorry, I feel like I'm babbling again. Don't know if I want to cry or scream! THANK YOU ALL FOR YOUR THOUGHTS AND POINTERS!!!

[Poorehouse 18]

I have UHC and the policies are all different however; If you are doing a revision then that is not the same as a new never had weight loss surgery. You have already met your 6 month criteria when you had the band put in. The person sending the info to insurance will and should be sending ALL your medical records including your 6 month requirements. Also MY doctor had me RE-fill out the questionary of everything I tried to so to lose weight and you can put your own dates on there. So don't worry about the 6 month requirement because technically you did that already

Second they are going to code your revision as a Medical Device (band) Malfunction. Along with all the other diagnosis you have. The fact that they will use malfunction or device failure that alone will usually get you approved!

It took me 10 DAYS to get my approval from UHC so if you want band to sleeve REVISION then go or it... All they could say is no but UHC is a very good insurance and I'm betting you will get approved.

I work in the medical field and I see this all the time. Good Luck!

My surgery is 10.24.13

[ribearty 544]

I have UHC and the policies are all different however; If you are doing a revision then that is not the same as a new never had weight loss surgery. You have already met your 6 month criteria when you had the band put in. The person sending the info to insurance will and should be sending ALL your medical records including your 6 month requirements. Also MY doctor had me RE-fill out the questionary of everything I tried to so to lose weight and you can put your own dates on there. So don't worry about the 6 month requirement because technically you did that already

Second they are going to code your revision as a Medical Device (band) Malfunction. Along with all the other diagnosis you have. The fact that they will use malfunction or device failure that alone will usually get you approved!

It took me 10 DAYS to get my approval from UHC so if you want band to sleeve REVISION then go or it... All they could say is no but UHC is a very good insurance and I'm betting you will get approved.

I work in the medical field and I see this all the time. Good Luck!

My surgery is 10.24.13

UHC didn't view it that way since the surgery for the band was performed under my husband's coverage and my sleeve is under my policy. We each have a different employer. UHC received the paper work from my doctor documenting the issues with my band on 9/11 and they approved my claim on 9/18. I am having my surgery later in October due to work obligations.

You never know how they will rule. They could have said take the band out and continue with the six month diet. You never know how they see things.

I have never had a problem with UHC coverage. I believe they are one of the most reasonable insurance companies.

Edited October 13, 2013 by ribearty

[Poorehouse 18]

Wow I agree with you. I really have ha great success with UHC... Good luck! Maybe we will have sleeve same time mine is 24th ... I have already did the math in my head and I MIGHT get real food for Christmas even if it is just mush ahahahah

[Bkhuffman292 1]

Bad news all the way around. Cigna OAP denied Sleeve, denied removal unless emergent. Their reason's where I did not have bariatric doctor appointments for over 3 1/2 years. I moved away from my original surgeon the closest doctor was 1 1/2 hours from my house so I never went. Also didn't know if I had coverage then. I wasn't having any problems till about 6 months ago. So, now I'm on a liquid diet 100g Protein, 30carbs and have to do it alone. The insurance coordinator said she'll submit for a repair to the band and see what they say. I'm not hopeful so I guess until I can't bear the reflux, gas, burping, abdominal pain and go for emergent surgery to have the broken band removed I'm on my own. Not very happy, but I guess its time to make some serious diet changes. PA stated I can live just fine with a slipped band if I eat small amounts and don't abuse it. Thoughts?

[Poorehouse 18]

Oh hell no I would not take that and give it! That band has caused soooo many problems in thousands I people and for the PA to say it's ok to live with a slipped band they are stupid! Find yourself a bariatric surgeon and get a second opinion they should know how to deal with the insurance company. And I may get blasted for this but I say you exaggerate all of your symptoms complain about everything all the pain you are having am at the very least get it removed. I have always hated Cigna! They are one I the worst to deal with! File an appeal

So sorry you are going through this I hate when insurance tried to play doctor.