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Trying for approval from Lap-Band to RNY - very frustrated

mom2sparky

By mom2sparky, in Insurance & Financing

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mom2sparky    2

mom2sparky
Posted

I am so frustrated. My United Healthcare policy will only pay for a revision if there is a malfunction with band, which means I have to get some kind of scope to see if this is the case. The surgery coordinator at my surgeon's office informed me of this yesterday, when she could have informed me last week. For whatever reason, the surgeon won't order this scope, I have to go to my primary doctor and request one, which wastes more time. However, I am going there next week, and I am sure one will be ordered right away. Problem is, there is probably not going to be any kind of "malfunction" with the band. I doubt it has slipped, and I would assume I would have noticed some symptoms if there was erosion. So if this scan turns out normal, I am screwed. Never mind that I have type 2 diabetes and severe sleep apnea, and the cost of my healthcare will be more expensive to UHC to shell out money for my medications, when this surgery could help end these problems. Has anyone else experienced this problem? Thank you in advance.

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kiwi201000    40

kiwi201000
Posted

I gave up on trying to get my insurance to cover it and am in the airport as we speak heading to Tijuana. $6800 for band to bypass revision... I didn't want to jump thru all the insurance hoops anymore.

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Pinkgirl1234    761

Pinkgirl1234
Posted

Yes insurance puts you through the ringer.I was having pushback about tests etc. Finally went to the ER after one of my vomiting episodes.It forced them to do an upper GI an they uncovered a mild hiatal hernia.Then had to go to my primary to get a referral for an endoscopy.He found nothing.Had the band unfilled.It only had 2cc's to begin with...ugh.I was told I had a "torturous esophagus".It was in the report! I am going through all the hoops...just saw the pulmonary doctor and he is recommending me for a sleep study....sleep apnea he thinks...now gotta see if insurance covers in home or clinical.Had a stress test.Insurance denied Echo and the nuclear stress test so I had basic.Now I am trying to find a Psych for evaluation.Very few want to accept insurance and scheduling is an issue.I am going through the hoops but I don't have money to self pay.

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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.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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
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