insurance pay from lap band to sleeve

[lauriearnold 40]

KM30381 i went today for my scope and my band did not sleep or prolapse. My band eroded into my stomach so i too am going to have band removed on 11/3 and have to wait a few months to let that heal then do the sleeve that is going to be self pay

[neyney75 0]

I am sorry you got denied. I would still try to appeal...also just a thought, most companies have open enrollment starting in November for January 1st. Could it be possible there is a different plan that might be offered by your employer that you could change to?

I would contact your HR Rep and maybe see about this. I would still do the removal, especially if you are having issues, then maybe (fingers crossed) you could get the revision through an updated plan???

My employer, or husbands, is with UHC. My lap band was covered with UHC with a different employer. It was very easy, just had to show 5 years of weight and co morbidities if needed, which I had. Was approved the first time, no hoops. No NUT to deal with or anything. I was sure trying to get the revision I was going to run into issues. Still with UHC but with a different employer. But it was approved the first time, still just needed to show the 5 year weight history, co morbidities, etc. Just found out I was approved for removal and to get either the sleeve or RNY. Still not sure which one I am going with, so surgeon advised of both to them. Scheduled for surgery 12/4.

I wish everyone could have it that easy. I thought for sure I was going to be rejected. Some how the stars lined up and pushed me through.

But I really hope maybe some plan change etc could be done to get you approved for next year? I would not give up hope and really talk to someone in your companies HR to see what is written in for the plan. Like someone else said, each company is different. I used to work for UHC as a rep for the companies, and most don't know that it is their employer that actually sets the plan limits. Some employers are self insured, meaning that all UHC does is manage the plan and your employer pays all the medical cost to a certain point, like hitting max out of pocket, then UCH pays. Then there are other employers that are fully insured, meaning UCH (or any health insurance for that matter) pays all the claims and they have control over what is approved or not. So a lot of it depends on your employer.

Wish I could offer more help than that, but hopefully that gives you a little more something to work on.

Best of luck to you!!!

[Dream4tc 192]

If there is a documented problem with the band, then it is considered a complication and insurance will cover, but it has to be documented. Most of the time insurance will cover removal and revision to sleeve if you still qualify for bariatric surgery with BMI >35 and comorbidities.

Best of luck to you

[lauriearnold 40]

I've appealed 3 times, talked to our employer, the HR, and my dr even sent 2 letters to them regarding this and they still denied it. so no big deal, i have the money to pay for the sleeve, insurance is paying for the removal so i'm just going to go on.

[lauriearnold 40]

No UHC did not pay for sleeve. they paid to have it removed and all that. I ended up owing like $441.00 total after this. I had lap band removed a week ago Monday and i'm still in pain, have a drain and letting my stomach heal now. It's going to take 3 months to heal then i can do the gastric sleeve which is what i'll have to pay for. I have UHC Choice Plus luv.is.patient1

[teshadb 203]

I had MVP with the band and they were a hell no once in a lifetime for surgery. Then thankfully and miraculously my insurance at work changed to Empire Blue I thought I was a shoe in. I had high Bmi still PCOS blah blah blah. Nope they still denied me. Tried to say I didn't do what I was suppose to after the band. Which was NOT TRUE. The doctor then tried to get approval for me by talking to the insurance company. Again denied. So I went on to prove them wrong! I dug back into my bank account showing all the months of weight watchers I did, all the orders of medifast I made, receipts of all the workout equipment I bought. Proof of me paying out of pocket for band adjustments when I didn't have insurance. Took pics of my workout equipment in my basement and wrote my letter stating all the issues and struggles I have had with my weight all my life and with the band and I was APROVED AND IT SAID ON THE LETTER IT WAS MEDICALLY NECESSARY!!! Don't give up send in everything you can when you appeal if it gets to that, circle underline highlight and give dates if you can. Good luck to you.

[BeautyLocs40 16]

My insurance company approved my band removal and request for a sleeve in July. When my removal was scheduled, I received a letter from them saying the surgery hadn't been authorized. I spoke with the insurance coordinator at my surgeon's office, and she said the authorization had expired and simply needed to be renewed. She didn't think it was a big deal until I told her as of September, BCN had changed its contract to read bariatric surgery is a once-in-a-lifetime benefit and asked her under which contract the renewal would be considered. She said she didn't know.

A couple of weeks later, I called her back and she told me BCN had once again approved both surgeries. I had the band removed yesterday, but have to wait until February for the sleeve. Admittedly, I'm concerned the insurance company is going to change its mind again, and I'll end up tens-of-thousands of dollars in debt.

Does anyone know the origins of the once-in-a-lifetime benefit regulation and if it applies to any other surgery? Just seems punitive.

[lauriearnold 40]

i know my insurance said once in a life time. I have a friend who had bariatric surgery years ago with a different insurance and just recently she tried to get the sleeve since it had been almost 15 years and her new insurance company picked it up and denied her cause they seen where she had already had one and denied her 3 times. good luck girl1! I'm just forking out the dough cause i'm tired of fighting with UHC, after 3 appeals and the dr sending in all kinds of stuff, i'm just done. It's been a week since my band has been out yesterday (Monday) and i have to wait 3 months for total healing before i can get my sleeve. Got to let stomach heal or i'll more likely have a leak.

[BeautyLocs40 16]

You know, LaurieArnold, you're right. I've given way too much power to the insurance companies. This process is about me.

[lauriearnold 40]

exactly BeautyLocs40, we have to take care of ourselves and think about us for once. so many things come before us a lot that it's time for some "me" time for us. I just got back from my follow up dr appt. they removed the drain, thank god, that was the worse part of it all. Now i have to wait 3 months to get the sleeve so I told him to mark his calendar and get ready cause i'll be back to schedule my sleeve. it's going to cost $16,700 and i am going to be a self pay on it but idc, i'm doing this for me. Insurance can kiss my butt, lol