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Lap band to revision denied!

lace131

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lace131    15

lace131
Posted

A few years back my insurance didn't cover bariatric surgery. So in desperation for change I went to Mexico and had a lap band. Right away I got pregnant and did not get to use the band properly not to mention I had to pay cash for my fills. So now 4 years, I have been getting fills and unfils trying to find my green zone. I throw up a lot and the GERD is unbearable. Not to mention I haven't lost any weight. I have increased my exercise and see the dietician. Even signed up for extra nutrition counseling out of pocket. Well I want to have a revision and my insurance denied me. Said I haven't used my band the way I was supposed to and didn't have enough follow up care. I don't have high blood pressure or sleep apnea. I have pcos and sever GERD. I live on protonix bid and tums at least 3x a day :(

I'm so heart broken and discouraged!

Let me clarify. My insurance does cover bariatric now. And many of my coworkers have had the surgery some who even weigh less than me :(

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James Marusek    5,244

James Marusek
Posted

Does your current insurance cover band fills now? I am not a fan of Lap-Band. More people are having them removed than putting them in today. One of the individuals in our bariatric support group meeting had a revision from lap-band to RNY gastric bypass because the band wore into his stomach and it was about to rupture. Health insurance can be difficult. But sometimes you need to play along.

Said I haven't used my band the way I was supposed to and didn't have enough follow up care.

So follow their advice. Sounds like that is what you are doing (and document it). And see what happens. But also keep the pressure on. GERD is a bad sickness and can lead to other big problems. If you do get surgery, RNY gastric bypass is the type to shoot for, since Sleeve will only make GERD worse.

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marimar66    15

marimar66
Posted

I self paid my band in Mexico almost 11 yrs ago. At the time I paid around 9,000 for the surgery. I went through all the trying to find the "sweet spot" and was never successful. A little over 4 months ago I made the decision to return to Mexico to have a revision from band to gastric. I paid around 6,000 to have the band removed and have gastric done. BEST DECISION EVER!!! dr. Ponce de leon in Tijuana through Bariatric Pal was a great experience. I borrowed the money and would do it again in a minute. Down 70lbs and going. I feel great! I wouldn't waste any more time trying to make the band work. You deserve to have a surgery that works for you. :) Good luck.

Sent from my VS880 using the BariatricPal App

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lace131    15

lace131
Posted

If I could borrow the money I would!! I am tired of living in this prison. I barely eat d/t my band and throw up many times a day/week and I am not loosing any weight, however I am not gaining either. :)

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marimar66    15

marimar66
Posted

lace131 I feel your pain. I was lucky enough to get a credit card from capital 1 with one year no interest. There were other loaning options with less favorable rates, which I was ready to pay if I had to. I was so desperate I was ready to borrow against my house if I had no other option. Before I investigated the surgery in Mexico I was even willing to go into debt the 25-30 grand that the surgery would have cost in the US. Keep trying to find a solution. Insurance companies are so frustrating!

Sent from my VS880 using the BariatricPal App

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Pinkgirl1234    761

Pinkgirl1234
Posted

Lace131...girl I was right there with you...trapped,ill and miserable with that lapband.Keep going to the doctor,emergency room etc...document everything.?..start the process all over again...fight to get approved.Call the Lindstrom patient advocacy group....fight for your revision.

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Whitefoot    14

Whitefoot
Posted

I had insurance problems with getting my band removed. I hired Lindstrom group to help me fight them and I got approved. Well worth the extra cost.

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Sheriberi    21

Sheriberi
Posted

I got denied twice, called lindstrom and they gave me great advice. EVERYONE is entitled to 2 denials then you may ask for an external review . Please don't give up. My revision from band to rny is happening in 3.5 days. Good luck to you

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WantToBe    77

WantToBe
Posted

My insurance denied my lap band removal also. Surgeon did a peer to peer and it was approved. I'm getting sleeve on 5/ 25. The insurance (same company and policy) approved me in two days.

I agree with others FIGHT the insurance company. When I was banded I threw up almost everyday and I never knew which foods would work for me. It was a long 11 1/2 years.

Good luck!

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NewMeBefore40    27

NewMeBefore40
Posted

I was denied a really revision due to lack of 6 Month diet so I just had it removed. I couldn't take another day like that. Now I'm working toward getting sleeved. However our insurance changed in Jan and no one can give me a straight answer as to whether bariatric is covered.

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Sheriberi    21

Sheriberi
Posted

I was in the same boat and was denied for revision 3 times . Do not give up. Appeal and then if denied file a grievance and a peer to peer interview . Contact lindstrom obesity advocates they will get you approved and their fee is small and you can make payments . I'm 2 weeks out from my revision. Don't give up

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Go To Topic Listing Revision Weight Loss Surgery Forums (NEW!)

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
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      · 1 reply
      1. summerseeker

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