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Denied again and surgeon's office is silent

IMissVegas

By IMissVegas, in Gastric Sleeve Surgery Forums

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IMissVegas    23

IMissVegas
Posted

BCBS denied my lapband removal and revision to sleeve again. I received a letter saying that since my first bariatric surgery didn't get results, they wouldn't pay for a new one. This is despite the fact that I'm down 80 lbs and am in pain at the port site. To make things worse, the Nicholson Clinic seems to have forgotten me. I have to email and ask for a status or I never hear from them.

Since I've met my OOP for the year, I met with an orthopedic surgeon and am having knee surgery on both knees next week. That way, I can exercise again. I feel that BCBS denied me because I've met my deductible and OOP and they don't want to pay for it. So now they can pay to fix my knees.

Yes, I'm angry. What am I supposed to do about the port pain?

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ppressey24    254

ppressey24
Posted

BCBS denied my lapband removal and revision to sleeve again. I received a letter saying that since my first bariatric surgery didn't get results, they wouldn't pay for a new one. This is despite the fact that I'm down 80 lbs and am in pain at the port site. To make things worse, the Nicholson Clinic seems to have forgotten me. I have to email and ask for a status or I never hear from them.

Since I've met my OOP for the year, I met with an orthopedic surgeon and am having knee surgery on both knees next week. That way, I can exercise again. I feel that BCBS denied me because I've met my deductible and OOP and they don't want to pay for it. So now they can pay to fix my knees.

Yes, I'm angry. What am I supposed to do about the port pain?

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How long ago did you get your lapband? You said you lost 80lbs, what else does BCBS want you to do? Some stories ive heard has been horrible. The insurance companies dont realize that they'll end up paying more if you have to have a sleep study because youre over weight,what about diabetes and arthritis? All these things come into play when were over weight. They just dont understand . Well, i would take myself straight to their office and sit myself there until someone give me some answers, i just wouldnt take this denial 2x. Especially when its for something as important as this. Ive had to have double knee surgery before also, its not nice. Good luck honey

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Dairymary    533

Dairymary
Posted

If you can find a bariatric program willing to work with you, you may look into submitting for revision due to medical complications, not "failure" to lose weight. I have seen dozens of patients revise from band to bypass or sleeve because of erosion of the stomach, slipped band, hernias, infections, etc. In your case you have port pain. It's typically a matter of documentation and coding. Also seen insurance approval of sleeve to bypass due to GERD. The patient's weight loss or lack thereof didn't factor in if there was a medical problem associated with the surgery.

But if all else fails, you can try Mexico. That's where I had my VSG 6 years ago because it was still considered experimental in the US and insurance wouldn't pay for it. In fact, my surgeon specializes in revisions.

Good luck with your knee replacements! Ugh!

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WGH3IWDT    93

WGH3IWDT
Posted

Suggestion, BCBS Approved my Band and Sleeve without any problems.

I suggest you wait till next year to try again to get it approved, ESP since your deductible starts over.

And I'm sorry they are giving you problems.

I HOPE AND PRAY THAT THEY APPROVE YOU NEXT TIME

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Aggiemae    739

Aggiemae
Posted

My insurance company allows one bariatric surgery per lifetime.

There is an exception for mechanical malfunctions with the band. They test the band and if it is functional they will not replace it.

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IMissVegas    23

IMissVegas
Posted

The surgeon's office called today and said if I go out of network next year to a specific hospital, then it will only cost me about $200. Apparently the hospital won't charge me a deductible or co-pay. This makes no sense to me. I have out-of-network benefits but why would the insurance pay for the surgery at all, even if it's for a hiatal hernia?

I told the surgeon's staffer to call me back next week. I'm still on painkillers after my double knee surgery and this is making no sense to me.

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Mimi52    103

Mimi52
Posted

I have Aetna and they denied me also, they approved removal but not revision. I wrote a long detailed appeal, showing all the issues I had wit the lap band, dates of fill, slips and so on. Got all info from dr notes. Finally after 30 days they approved. I know there are law firms that help with appeals to insurance if you want to go that route. Sorry not sure of the cost. Hopefully an appeal will work.

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earleb    12

earleb
Posted

Belite.com Las Vegas NV has payment plans as well. If paying out of pocket

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