Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Band to Sleeve Revision Struggle with Insurance Approval



Recommended Posts

I had a successful lapband placed in 2012- I'm 5 foot 3 - I went from 230 to 145 lbs. I even went thru a pregnancy and only gained 15-20 lbs or so and instantly lost that after I had my baby. I loved my lapband. I only had about one or two fills. I wasn't a fan of the port but I lived with it. I never had any problems. About 10 months after I had my child I started having acid reflux problems and went into see the doctor oct 2016. He checked my band and stated that it needed to be removed immediately he thought it was eroded and wasn't sure.. So he removed it. We talked about revision to the sleeve. We removed it the next day. There was no erosion but there was some slippage. Then he told me to the heal and go thru the holidays and we would start the process of the revision process. So come Feb I went back in and we started the entire process with the test and insurance mess I have been thru all the appeals the peer to peer I have finally hired the lindstrom attorney. I am on my final appeal. I am sooo frustrated insurance keeps denying me (BCBSofNC) stating that I do not have the BMI. When clearly in my insurance it does not state that you have to have a high bmi for a REVISION!!! I mean I am not going to be over weight when I just had a successful Lapband REMOVED!!! Which clearly now I am back up to 200lbs ! and the attorneys are fighting that.

Has anyone else had this problem? Why is insurance so stupid? They are seriously going against their own writing word they wrote. I wish I could have gone back to that day at the doctors office and asked more questions and also let them unfill and just see how it was instead of acted so quick. but the doctor made it sound so serious and I was so emotional to lose a tool that work and made my life so great!

Now I have gained weight and depressed about it. and it has been a year and battling this stupid insurance company that can't get it thru their head - about a BMI for a revision after a lapband removal...

Share this post


Link to post
Share on other sites

I am in a similar situation! I am 5ft 5in and lost over 100lbs. I went from 252lbs to 149lbs. I struggled with infertility and gained a lot back. Pre pregnancy I was about 210lbs but lost while pregnant. 1 week post par-tum I was 195lbs! The next year I fluctuated between 195-200lbs. In September I went to talk about revision and they said my BMI was too low. So, I had some Fluid removed from my band and now I'm up to 215 and I also have sleep apnea so I'm hoping insurance approves me. Insurance sucks.

Share this post


Link to post
Share on other sites

I was told the insurance company will only approve 1 surgery. luckily I worked for a different Co & had different Ins. I

Sent from my SM-G930P using BariatricPal mobile app

Share this post


Link to post
Share on other sites

I’m with different employer company (government employer now before it was a private employer ) but same insurance company though :( it’s so aggravating!!

Share this post


Link to post
Share on other sites

I'm in the process of. I had a BMI of 34.2 (under the 35 needed) when I went for my first apt. Still had my band in will find out very soon if the insurance company approves. I finished all prior tests cardio, endo, nutrion, sleep, ultrasounds, xrays etc and on the 29th I need my gallbladder out. I also had to lose 10%of my body weight so fingers crossed. PS. I hate insurance, don't give up.

Sent from my SAMSUNG-SM-G928A using BariatricPal mobile app

Share this post


Link to post
Share on other sites

I just got revised and unfortunately had to qualify all over again! Doc saw I was losing weight and said to stop and also no preop diet. Bmi had to get to 35, then of course knees hurt etc in order to justify them paying for it!
I met a lady who said she had to fight for years to get them to cover her revision


Share this post


Link to post
Share on other sites

And you're right it is stupid. I have to sit 6 months gaining weight, getting depressed, knees and joints aching, blood pressure up etc then I finally qualified


Share this post


Link to post
Share on other sites

danigurl: did Lindstrom end up getting you approved?

Share this post


Link to post
Share on other sites

On ‎10‎/‎19‎/‎2017 at 1:51 PM, DaniGurl87 said:

I had a successful lapband placed in 2012- I'm 5 foot 3 - I went from 230 to 145 lbs. I even went thru a pregnancy and only gained 15-20 lbs or so and instantly lost that after I had my baby. I loved my lapband. I only had about one or two fills. I wasn't a fan of the port but I lived with it. I never had any problems. About 10 months after I had my child I started having acid reflux problems and went into see the doctor oct 2016. He checked my band and stated that it needed to be removed immediately he thought it was eroded and wasn't sure.. So he removed it. We talked about revision to the sleeve. We removed it the next day. There was no erosion but there was some slippage. Then he told me to the heal and go thru the holidays and we would start the process of the revision process. So come Feb I went back in and we started the entire process with the test and insurance mess I have been thru all the appeals the peer to peer I have finally hired the lindstrom attorney. I am on my final appeal. I am sooo frustrated insurance keeps denying me (BCBSofNC) stating that I do not have the BMI. When clearly in my insurance it does not state that you have to have a high bmi for a REVISION!!! I mean I am not going to be over weight when I just had a successful Lapband REMOVED!!! Which clearly now I am back up to 200lbs ! and the attorneys are fighting that.

Has anyone else had this problem? Why is insurance so stupid? They are seriously going against their own writing word they wrote. I wish I could have gone back to that day at the doctors office and asked more questions and also let them unfill and just see how it was instead of acted so quick. but the doctor made it sound so serious and I was so emotional to lose a tool that work and made my life so great!

Now I have gained weight and depressed about it. and it has been a year and battling this stupid insurance company that can't get it thru their head - about a BMI for a revision after a lapband removal...

I was approved with UHC on my first submit. I have the lapband and esophagus issues. I went in for a fill, took a barium test and found issues with my esophagus/swallowing. Since last summer I've slowly been gaining weight. I've been eating great, excising, active, etc. EVERYTHING the same. I'm around 170 but was 135-140 since being banded (SW:230lbs) Dec 2011. My Dr. submitted me for removal and revision in early July. I was approved 11 days later for both. My insurance for the band was BCBS but UHC covers me now. I was really expecting to go through the peer to peer review. I do have high BP and now have a hiatal hernia due to the weight gain...I'm total apple shape. Stay on them! Good luck. You're doing the right thing. The Lapband is starting to show the long term affects...I wonder why there's no class action. Insurance sure knows the failure rates are at an all time high. It's even in their best interest to approve. They'll end up spending so much more, at least on me. Isn't healthcare all about preventive care? There is no way in hell I was taking it out without revising to something else. Getting to my normal weight has changed my life in ways I never thought possible. Keep me posted. I'd like to know if you win your appeal/case.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 2 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×