BCBSIL Revision approval success?

[whiterabt 0]

Hello -

I'm going in for an endoscopy on Thursday to determine if I have a band erosion or slippage. I've been experiencing bad acid reflux, increasing tightness and last Thursday, found myself in the ER after vomiting blood.

I had an emergency unfill and fluoroscopy over the weekend (I thought I had 1cc in my band but it turned out to be 3!) and am feeling somewhat better, but am still fighting with acid reflux.

My surgeon thinks the likely outcome will be that I've experienced an erosion or slippage. I've had the Realize band for six years without complication, lost 80 lbs at my best, but have been maintaining a 60lb loss for the last several years. My BMI is still just over 29.

Should I need to have the band removed and reconstructive surgery done on my esophagus and/or stomach, I'm thinking the gastric sleeve may be the best way to help me keep the weight off that I fought so hard to lose.

I'm reading mixed reviews about the BCBSIL approval process. I have their PPO+ plan, and if my band has failed from erosion or slippage, I believe I qualify at the most basic level. However, my BMI is considered low, and my first surgery was self pay.

BCBSIL will end up paying the same amount of money for esophageal and/or stomach surgery to repair the erosion and any malformation or scarring in my upper GI, but I know the insurance world operates by codes and scripts so this justification may be lost on them.

Any advice you have for navigating the waters of dealing with insurance companies would be much appreciated!

xo,

-e