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Band out. Round 4 with insurance

km30381

By km30381, in Gastric Sleeve Surgery Forums

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km30381    2

km30381
Posted (edited)

I got my lapband in 2006 and loved it.I lost over 100 lbs and felf great. However it needed to be removed due to slippage. Medical necessity, not by choice. It was removed last November 2014. I got two Doctors opinions, both prefer to do the two surgerys seperately to give everything enought time to heal. I am now fighting with insurance company. My wonderful Doctor did have a peer to peer with my insurance company to explain why he felt I needed the revision to the sleeve. I have written 2 appeal letters and have been denied 3 time. It is now in the hands of a third party. I was wondering if there are others out there with similar storys. I am going to have the surgery regardless even if I have to self pay, which would wipe out all my savings. Keeping my fingers crossed.

Edited by km30381

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liannatx    897

liannatx
Posted

I truly hope that your insurance has to pay.

I also had to wait between band removal and Sleeve, my surgeon said that once he was in there my stomach was in no shape to do the revision at the same time. Those months past super fast though and the Sleeve surgery and recovery went smoothly. I will be crossing my fingers for you also.

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peacheeie    14

peacheeie
Posted

Hi...I too had the same issue! Band out in sept, sleeved in January...major fight with CIGNA...denied 3x's even after 2 peer to peers. Hold onto hope and talk, really talk to your doctor. Wording is key with insurances...trust me! I did have a hernia though. I too had scar tissue and therefore my sleeve is larger than the normal 15%. I only have 50 lbs to loose and in 3 months have lost about 20...loss is very slow and I am frustrated but I am working my sleeve and I will not let it work me!! I am not sure if waiting would have improved the scar tissue and allowed the standard size sleeve so look into that and ask (just an opinion from my personal experience) IM me if you would like too :)

Dee

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LSF    264

LSF
Posted

@@peacheeie,

I'm curious, where did you have your surgery? Did the Dr say you had a lot of scar tissue? I know we've talked because we have the same insurance

Lori

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peacheeie    14

peacheeie
Posted

Hey Lori....bayshore hospital in holmdel. Apparently I had so much scar tissue that the sleeve could not be the normal size. I'm going to request the pathology report tomorrow to see how much actually was removed.

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LSF    264

LSF
Posted

I'm curious If they can do it again to the correct size. I had minimal scar tissue and I can feel the restriction. I'm having trouble getting all the Water in though. One week I gained a pound so I said "screw it" and had 1 cup of Pasta for dinner one night. Then I lost 1.5 pound. So now I'm trying to up my carbs just a little bit. Good luck & keep me posted on how your appt goes

Lori

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Go To Topic Listing Gastric Sleeve Surgery Forums

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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.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
    • KimBaxleyWilson

      KimBaxleyWilson

      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!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      bellaamey

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