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Hi, All:

I was banded in 2009 and never had much success with it. Any time I got restriction, it came with a lot of heartburn (which manifested itself as nausea). I also struggled with a lot of food intolerance. Eventually, because my insurance switched and I have a written exclusion regarding bariatric surgery, I had the band mostly unfilled due to too much restriction and cost.

At any rate, in January, my health insurance plan will now include bariatric surgery, although it’s unclear as to what language looks like regarding revisions. One concern I have is how to make a case to the insurance company deeming the revision medically necessary. I have had many EGDs, which showed mild irritation in my esophagus, but nothing extreme. Grandest, it’s been almost 10 years since anyone’s looked at the band and who knows what the current state of affairs is—I will have an evaluation once my insurance kicks in.

Does anyone have any suggestions or tips in dealing with insurance companies covering revision when severe symptoms, slippage, erosion, etc isn’t present?

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I was banded in 2012 and now I am doing a revision to the sleeve with insurance. I have Aetna and they pretty much approve anything. I did have a revision on the band in 2015 due to acid reflux and my gallbladder. After my gallbladder was removed I started to gain the weight I lost back and the band gives me horrible pain in the port. If possible I would see if your insurance shows the clinical information on what they approve for certain procedures and what the requirements are to get approved. Aetna has it where you just call them and tell them what you are trying to do and they give you a clinical id that tells you what you need to be approved. Based on that information I should be approved soon for my revision to the sleeve. I would just check with the insurance company and ask. I hope this helps.

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Your surgeon's office will have the best guidance. They go through the hoops all the time. It's not your problem to figure out.

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Thank you both, Orchids&Dragons and MsBosse! I appreciate your insight. I really have no clue what the policy will look like until open enrollment since it was previously a written exclusion and this is the first time they've covered it. I'm a state employee with group health insurance/uniform benefits, so I'll be curious to see if each plan will have the same language regarding revision, or if they'll be different. I spoke to a nurse with the bariatric program last week and felt a little defeated because I felt like she was pushing towards the idea that if there's nothing wrong with the band, I'm SOL. Now, whether or not that is true, I don't know. That may just be me being hyper-sensitive.

Again, I appreciate the feedback from you both! Once the plans are out, I'll start digging, calling, and consulting. Thank you!

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        The difference in price for a mini arm lift and the full arm lift at my surgeon is less thank 2K and probably not worth the savings. May as well pay the extra bit and get the full arm lift as my sag also reaches my elbows. You are right though, my arms see the light of day way more than my butt does...I'll have to see if the continued butt exercises will change my mind down the road (but it's looking more and more that a butt lift is in my future)

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