Removal/Revision Approved!

[3nuthut 32]

I wanted to post this to the LapBander’s out there...

Banded Dec 2012 and was doing great!

I went from 230 to 138 and stayed that way with fills up to the end of 2015.

Then when I got to 165 in Feb of 2018, I went in for a fill and they found that my band had slipped and I started having lower muscle esophageal problem. I’m thinking great...my BMI isn’t high enough to get the revision paid for and I don’t want to have to go through proving AGAIN, that I need a tool for managing my weight. Plus, my blood pressure is starting to go through the roof! (I’m apple shape so my fat is around my organs)

The dr told me I would probably get a denial but we could appeal and do a peer to peer review.

Low and behold after waiting 1 week, on the first submission, I got approved.

surgery is August 13th 2018!! Eeeek!!

I have United Health which has a “once a lifetime” bariatric surgery coverage ( BCBS of Texas did my band).

So for all those who are thinking about a revision or band not working, I highly recommended checking into it.

[wonderband 2]

I have been searching for you!!!! I am currently waiting to see if I will get approved as well. I got banded in 2010 and had done well until this past year. I have gained 45 lbs and it has been overwhelming. I am worried that they will not approve me due to the low BMI. You have given me hope. Good luck and I hope we can keep in touch throughout this journey.

[3nuthut 32]

I think more and more insurers are approving these band revisions ( I don’t know anything about sleeve to bypass). I’m not just dealing with weight gain, which is not above even 30...going down that dark path and fastI, but now the muscles in my lower esophagus have started to weaken and deteriorate, food is stuck all the time, the port has caused a hernia, and the band has slipped. And all this happening out of the blue within the last 5 months!

[deltadentist1913 1]

Good morning. May i ask what your process has been? I’m in the same position as you. I was banded in 2010. It worked wonderfully until this past year. I had to undergo all the same pre op requirements again and am very nervous that i won’t be approved.

[3nuthut 32]

I had started slowly gaining weight starting last year. Changing NOTHING in what I ate, but eating more of it. So I scheduled a fill and they requested I do the barium swallow test. They found that my lower esophagus looked like it was “quivering”, and it kinda did. So I never got the fill. Three different esophagus tests later, my band had slipped and due to my weight continuing to gain, my hiatal hernia is back. So basically my process has been the tests...basically a breakdown of the esophageal muscles. I don’t have to go through the 6 month requirements. Maybe due to the urgency of getting the band out???

[wonderband 2]

@3nuthut I got denied today from my insurance. I am afraid I am going to have to live with the band. I am extremely scared of living without anything. This is Deltadentist. I have two different names dependent upon computer or phone login

Edited August 4, 2018 by wonderband

[Frustr8 7,886]

So very sorry, can't you file an appeal? Have your doctor state is now a medical necessity not a measure of convenience on your part. Got to be SOMETHING that can be done. What excuse did they give for rejecting the you?

[wonderband 2]

not a medical necessity. BMI too low. No complications with my band

[3nuthut 32]

@wonderband I’m so sorry to hear. Ha e all your appeals been denied? That was my biggest fear too!

[wonderband 2]

I will call my doctor tomorrow. When I got the letter stating they needed more information, I received it before my doctor's office did. I imagine that will be the case again. I will see what their advice will be.