Slipped, Denied for Revision to Sleeve - Can "live with" slip

[Bkhuffman 28]

So I feel like I'm ranting, but I'm really searching for information. My 08 band has slipped, pouch is stretch, so-on & so forth. Insurance WILL NOT pay for revision to sleeve - denied for not seeing doctor for 3 years, might not cover fixing of this band and will only cover "emergent" to take the band out. The PA said I can live on a 2-4 week liquid diet, high Protein, low cards and they'd try to submit for insurance to cover going in a repositioning this band. Is this safe? They think I can live with the "complications" of the slip by not over eating, swelling my belly/pouch, and making better choices. When, or IF, the band causes such discomfort they will submit for emergent surgery to take out. I'm really lost, pissed, and getting fatter by the day - what would you do? Do I fight with insurance doctors? My next appointment is Nov 4th to review my liquid weeks and see how I'm feeling. If I choose good foods and don't over eat the symptoms are much less, burping, pain in back/shoulder, reflux, but if I do what overweight people do - EAT and eat wrong then I pay. Thoughts anyone?

[NaNa 878]

So I feel like I'm ranting, but I'm really searching for information. My 08 band has slipped, pouch is stretch, so-on & so forth. Insurance WILL NOT pay for revision to sleeve - denied for not seeing doctor for 3 years, might not cover fixing of this band and will only cover "emergent" to take the band out. The PA said I can live on a 2-4 week liquid diet, high Protein, low cards and they'd try to submit for insurance to cover going in a repositioning this band. Is this safe? They think I can live with the "complications" of the slip by not over eating, swelling my belly/pouch, and making better choices. When, or IF, the band causes such discomfort they will submit for emergent surgery to take out. I'm really lost, pissed, and getting fatter by the day - what would you do? Do I fight with insurance doctors? My next appointment is Nov 4th to review my liquid weeks and see how I'm feeling. If I choose good foods and don't over eat the symptoms are much less, burping, pain in back/shoulder, reflux, but if I do what overweight people do - EAT and eat wrong then I pay. Thoughts anyone?

If your current employer (if your insurance is through your employer, it's NOT the insurance company that is denying your revision to the Sleeve, it's probably an exclusion with your employer's insurance policy.

Your insurance CAN deny a revision to another type of weight loss surgery, but they MUST pay to either fix your band, replace it, or remove it.

That being said....you have a complication, and your insurance MUST pay to fix your CURRENT BAND. You can appeal it, but they MUST PAY for either to remove the band, fix it or they MUST PAY TO REBAND YOU.

You CANNOT live with a slip band forever, even with an empty band, your symptoms will get worse over time. So while you are only having mild reflux now, you may want to get your ducks in a row and appeal, appeal, appeal.

Going on a liquid diet, and only eating small amounts will help in the short term and relieve your symptoms, but it's only a band-aid, but eventually you will need to get your band out, replaced or a revision to something else.

There is an attorney call Lindstrom on Obesity Help that helps folks appeal, but you may not need an attorney, all you have to have is Upper Gi, and records of your band slippage and complications.

Also, it sounds like your surgeon may not be doing things right, you may need to get a second opinion with another surgeon, something does not sound right.

[MarilynJ6354 5]

I am waiting for approval to have my band removed. I have had esophagus issues for a year and after going to many doctors for the throat issues, having many swallow tests and EGDs, and having my band unfilled months ago, my surgeon said I am rejecting the band and it has to be removed. I asked if I can have a revision and he said "your insurance won't pay because you are too skinny." WHAT?! Well, it's because my BMI is lower now. So now I am waiting for insurance approval. I am unable to swallow most everything, even liquids. I haven't gained any weight; just haven't lost much in the last year but I'm determined to keep losing even without the band.

[Bkhuffman 28]

Well I'm not going to give up. I guess I'll try and diet the best I can - which is hard - i'm a food addict BAD. I don't want to gain or hurt, but the whole "liquid" diet thing is not for me. I'm praying they will fix me. the reflux and burning are relatively constant, the pain comes when I over-eat or eat fried. But in all honesty I can eat and entire burger, fries no problem. The band isn't working for me at all and I'm just not sure what to do. Without insurance covering anything I'm SOL. I can't self-pay again. I paid 14k for my band - which really pisses me off b/c why is the insurance saying anything - they didn't drop a dime. I guess I've got a long road ahead of figuring out what to do. thanks for sharing your stories and input. I'm constantly reading on other ppl's stories.

[kll724 3,055]

Bets wishes. Please do your followup!

[MarilynJ6354 5]

Hopefully you aren't over eating or eating burgers and fries. Stick to an Atkins type diet and should be fine. The problem is over time, the reflux will erode your esophagus and you will end up like me...not able to swallow Water. Don't wait. I am confused, though, that you said you haven't seen a doctor in 3 years?

[Bkhuffman 28]

From 08-09 I saw my "self-pay" doc - then I moved from SW FL to Vermont and didn't have coverage or a doctor within a 150 mile trip from my house, not to mention I couldn't afford to go. I didn't have any issue up there. I moved back to FL - other coast, husband got a GREAT JOB - praise the lord!! and I have coverage with Cigna. I started to climb in weight - Feb hovering 200lb - by April 217 - by June 230 - July 233 - finally went to see new Doc here. He ordered a fluoro and I had to wait 6 weeks due to $300 co-pay. At 238 for that test. Now I'm at 243 with a confirmed slip and no way to do anything but have "emergent" surgery to remove because I didn't comply and see a bariatric doctor for 3.4 years ... per the insurance. They won't approve the sleeve, the band HAS TO be causing me issues to get it covered to take it out and who knows if they'll allow the "re-positioning" of bad band - I'm not hopeful they will say yeah. If they will, i'll have the surgery and get this band fixed and start basically ALL OVER. In the mean time, yes, I can consume a whole burger with some fries - but I'm not because I learned real quick that isn't good. I really want the sleeve - but again, I'm not getting it. I've started an exercise program and I'm watching my intake with mostly liquid shakes - and lots of Protein. Very discouraged - thanks for advice - I surely do appreciate.

[danalay40 2]

You can do a liquid diet for a few weeks. Protein Shakes are filling, egg drop Soup is ok and it's filling. sugar free Popsicles etc. burgers and fries and your complaining, I'm not trying to be mean but you have to try harder than that. Whatever they do to fix the slip, good luck!

[Bkhuffman 28]

my burgers and fries day was "fat person frenzy" - what I find hilarious is the doctor telling me to live on liquid - hello Doc I had a weight loss surgery because I don't control myself. I haven't had another B & F's night therefore the reflux/pain has been minimal. I'm doing my best trying to control my eating, but I love food, I eat because it smells good, looks good, tastes great. I need to have this fixed, but I'm thinking the insurance is going to deny even the revision of my "broken band". I will update when I know and maybe its time for good ole' weight watchers again. I did join a gym and have been 2x in a week, wanted to get that third visit in, but life hit me hard - kid broke his foot & ankle.

[Leena 108]

I had a slip before- albeit minor and had a complete unfill to correct it. Thankfully it did and surgery wasn't required. Did you try an unfill?

Have you had an endoscopy to check for ulcers? Are you on an acid blocker? These are all things that can help with your situation.

Your insurance should cover a repositioning, now under obamacare pre-existing conditions are covered by default.

Conversions to other procedures are more difficult to get covered, a lot depends upon your insurance as well as your doctor's input. Insurance companies like to see difficulties documented over time (yeah it sucks but it's the reality of it). Do you have any check ups at your primary you could use as documentation? Things like that help.

[MarilynJ6354 5]

Was notified Monday that surgery was approved by insurance and got my surgery date this morning. It will be Monday November 25th, which is great since that is a short work week anyway. I can't wait until this is all over and I can start on my post-band journey of healthy weight loss. It gave me a good start, that's for sure.

[Bkhuffman 28]

I still have no word on revising this band. I checked with insurance coordinator yesterday and she said its still in pending. I'm not having terrible problems if I don't overeat, but I'm steadily gaining. Probably up another 2-3lbs. I have no self control and I just sit in front of a desk all day long. I'm about to start popping dextrim - LOL...I'm sure sometime in my weight loss trial and errors I did that.