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Lapband removal denied

bb00024

By bb00024, in Insurance & Financing

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bb00024    21

bb00024
Posted

Has anyone experienced that your RNY surgery is approved, but insurance denies to cover the removal of the Lapband. I can't have the RNY with the Lapband still inside me, so it doesn't make sense to me. However they approved the RNY. I have appealed and they still denied the LapBand removal.

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SoccerMomma73    1,867

SoccerMomma73
Posted

Are you having and negative issues with the band? Heartburn, pain, anything????? Mine was approved because I had a slip. I come up with every issue you can think of and talk it over with your surgeon. (Also, if he's doing removal at the same time as RNY you could pay cash for that portion....not a clue how much it would be though )

Good luck!!!!!!!

HW 312, pre-op (RNY) 255, current weight 217.2

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HeroOfThisStory    24

HeroOfThisStory
Posted

My insurance company has "revision" guidelines for WLS as a completely separate benefit so that may be something to look in to.

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SoccerMomma73    1,867

SoccerMomma73
Posted

The irony of being approved for RNY but unable to get your band removed is killing me.....I'd be developing severe abdominal pain :P NOT THAT I'D EVER SUGGEST YOU LIE!!!!!

HW 312, pre-op (RNY) 255, current weight 217.2

ElleG reacted to this

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Ms_Kb718    22

Ms_Kb718
Posted

How can they possibly find the RNY medically necessary but not the band removal? That makes no sense! You can't have the procedure that they determined is necessary if you still have the band. It's usually the other way around and the band removal is approved, but the RNY is denied. My insurance company took a total of 2 weeks to approve my surgery. I later found out that the band removal was approved in 2 days, but the rest of the time was spent gathering more info and determining whether or not the conversion to RNY was medically necessary.

Insurance companies are full of it. The sad thing is that because it's 2 procedures in one, the insurance company probably won't even have to pay that much for the band removal. Do you have the option for an external review? My insurance offers an external review if your appeal is denied.

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bb00024    21

bb00024
Posted

How can they possibly find the RNY medically necessary but not the band removal? That makes no sense! You can't have the procedure that they determined is necessary if you still have the band. It's usually the other way around and the band removal is approved' date=' but the RNY is denied. My insurance company took a total of 2 weeks to approve my surgery. I later found out that the band removal was approved in 2 days, but the rest of the time was spent gathering more info and determining whether or not the conversion to RNY was medically necessary.

Insurance companies are full of it. The sad thing is that because it's 2 procedures in one, the insurance company probably won't even have to pay that much for the band removal. Do you have the option for an external review? My insurance offers an external review if your appeal is denied.[/quote']

Well, great news. I met with a new surgeon and he agreed to do the revision and not charge me for the Lapband removal. Therefore, I am all set and ready to countdown to my surgery. I hope to have a tentative date set ASAP. Crazy insurance......

SoccerMomma73, MissNikki27 and ElleG reacted to this

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Ms_Kb718    22

Ms_Kb718
Posted

Congratulations!

Sent from my iPhone using RNYTalk

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ElleG    394

ElleG
Posted

That is the craziest thing, but I'm glad the doc is working with you he will make his money on the revision :) Best Wishes!!

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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    • KimBaxleyWilson

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      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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