I’ve had a lap band for 11 yrs. I’ve begun to have problems ( band intolerance) and also have gained 30 of 100 pounds back. I’m not considered obese anymore but I am wanting the band out and feel that I need the sleeve so that I don’t gain it all back. I’m disabled and have Medicare. Does anyone have experience with this.
Insurances seem to want you to gain it all back ( to have a higher bmi again ) before they will cover. They covered the band. Wouldn’t it make sense to cover the revision.

I would just go see the surgeon and see what They say. For revision if it’s medically necessary your BMI shouldn’t matter. For instance if you haD sleeve and develop untreatable GERD they wouldn’t care what your BMI was to revise to bypass. I am not sure but band intolerance may make it medically necessary.

Edited April 26, 20224 yr by ShoppGirl

1 hour ago, ShoppGirl said:

I would just go see the surgeon and see what They say. For revision if it’s medically necessary your BMI shouldn’t matter. For instance if you haD sleeve and develop untreatable GERD they wouldn’t care what your BMI was to revise to bypass. I am not sure but band intolerance may make it medically necessary.

My insurance didnt cover anything but i went ahead and asked them if i developed severe GERD if they could cover a bypass to cure it, They flat out told me no. LMAO i was like come on... haha.

Just now, liveaboard15 said:

My insurance didnt cover anything but i went ahead and asked them if i developed severe GERD if they could cover a bypass to cure it, They flat out told me no. LMAO i was like come on... haha.

Wow. That sucks. It’s sad that any insurance wouldn’t cover it and there are so many hoops with the ones that do.

7 minutes ago, ShoppGirl said:

Wow. That sucks. It’s sad that any insurance wouldn’t cover it and there are so many hoops with the ones that do.

It does. I would have to move to (closest place) would be North Carolina, Set up residency and get health insurance. There they would cover it.

1 minute ago, liveaboard15 said:

It does. I would have to move to (closest place) would be North Carolina, Set up residency and get health insurance. There they would cover it.

Well at least you have a plan. Lol

2 hours ago, Nanajoy said:

I’ve had a lap band for 11 yrs. I’ve begun to have problems ( band intolerance) and also have gained 30 of 100 pounds back. I’m not considered obese anymore but I am wanting the band out and feel that I need the sleeve so that I don’t gain it all back. I’m disabled and have Medicare. Does anyone have experience with this.
Insurances seem to want you to gain it all back ( to have a higher bmi again ) before they will cover. They covered the band. Wouldn’t it make sense to cover the revision.

I'm in the process of revision. My band was removed one year ago. I'm about to have bypass surgery very soon.

I can tell you that medicare covers revision and it's based upon medical necessity, and they review each case individually. I had GERD. So before removing my band, my surgeon did a couple of tests. An EGD and also a special fluoroscopy test that looks for dysmotility of the esophagus and also reflux/GERD. You basically eat a marshmallow and then a piece of bagel (if neccessary) on fluoroscopy while they tilt the table that you're secured on to certain degrees. It's almost like swallowing food at an angle. It's really strange. I didn't even get to the bagel before the marshmallow refluxed upwards and outward. The test reports are sent to the insurance company to establish medical necessity for removal. So because Lap Band failed me, I can get revision. So if you're having issues with your band, I would say you will be approved very easily. When you have issues with the band, those issues override BMI. Because you're not asking for revision so much for weight loss, but primarily due to the intolerance or issues the band has created.

I wish you well on your journey to revision!

Edited April 26, 20224 yr by BypassingMyPhatAss

Totally been there. Had a lapband for 11 years and kept off about 60 lbs. Started aspirating at night, and my surgeon determined that my band had to come out. I had the band deflated and my surgeon had me start a supervised diet at the same time while we started jumping through the insurance hoops to try to get a revision to gastric bypass. My bmi was 33 at this point. I'm sure he knew I'd gain weight, and I did -- about 30 pounds, which easily pushed my bmi up into the range for revision surgery.

I just got approved today to have a gastric bypass at the same time that the lapband comes out. It took me about 6 months from when I went in with problems to get to this point and jump through all the insurance hoops. July 6 can't come soon enough.

And yes, I agree that it's insane that you have to raise your bmi to qualify. It was the first weight loss surgery that allowed me to get my bmi down in normal range in the first place!!! It would have been SO MUCH BETTER to just have gotten the revision right away when the doctor determined the lapband needed to come out instead of gaining the weight back. It's a ridiculous policy.

I constantly reminded myself that while I was gaining weight temporarily, that my first weight loss surgery was successful and the revision will be as well, so it's a temporary pain in the rear in order to get a permanent solution. I feel your frustration and fully understand.

I’m on the same boat. I already started the process to get a revision to bypass with a BMI of 31. I had very bad GERD but the EGD only showed up a hietal hernia, and I guess Aetna guidelines says esophagitis. I’m terrified they would not approve me because of this ?