FXDF2008

January 10th for me. Former band patient. Had it removed due to erosion March 2012. Had to wait six months to heal then go through the insurance process which was a pain! Finally got approved 12/20/2012 and have started my pre-op diet today. I go next week for labs and EKG. Recently had a chest X-ray so don't need that again. I think I'm more nervous about this surgery than I was with the band since it is more extensive and I don't have a virgin stomach. I have scar tissue from the eroded band and also have another hiatal hernia to repair. (had one repaired when I got my band). I'm used to the change in diet and how to eat do that really doesn't bother me. More worried about the surgery itself and the recovery. Following others experiences on here really helps!

I haven't had my sleeve surgery yet but I lived with the band for four years and was very successful with it. I learned to live without things like sushi, soda and bread. It was so worth every sacrifice to be able to shop and find things that not only fit but looked fantastic on me. To be able to bend over and tie my shoes. To not buy tops based on how long and blousy they were so they covered my stomach and hips. To feel sexy again (at least with clothes on LOL). To be able to get out of bed in the morning and not hobble in pain from plantar fasciitis, knee pain and hip pain. I ride a motorcycle. People who ride motorcycles love to go ride to destinations that usually involve food. That's all well and good except when you are ashamed of how you look so you don't go at all. I'd rather deal with being jealous of those who get to eat all they want than to not be able to enjoy life because I'm ashamed of my appearance. There comes a point in time when you will hopefully realize that there are things in life that are far more important than food.

Hi Tad! My surgery is the 10th! I'll let you know how it goes! I start my pre-op diet tomorrow. Labs and EKG next week. Pre-op with surgeon next Friday. Education class on the 9th and surgery on the 10th. I'm freaking out a little!

You know? It feels like I've been riding on a roller coaster. For the past year I've been battling surgeon's offices and insurance coordinators in order to get approval for my revision to the sleeve after my band eroded. It has been like being at the start of the roller coaster where you are slowly but surely grinding your way up the initial peak. Well I just reached the top of that peak and now feel like I am going 100 mph down the other side of that peak! My surgery has been scheduled for January 10th! I begin my pre-op diet tomorrow and go for my EKG and labs next Wednesday. Holy crap!!!!!!!!!!!!!!!

Sounds like you are doing great! What a shining example! Hope my surgery goes as smoothly and successfully as yours! Keep up the great work!

My band eroded 40% so I had to have it removed then wait six months for the scar tissue to settle and the hole in my stomach to heal before having tests to determine if the sleeve was going to work for me (upper gi, upper endoscopy and esophageal manometry). I am good to go and just received the approval from my insurance company. I jhope to have surgery in January. So far my surgeon hasn't suggested that my weight loss will be any different but I will be sure to ask him.

Hi Tad! I haven't had it yet. I'm in the process of having it done and am hoping to have my sleeve surgery in January. I received my band in February 2008, it was diagnosed as eroded November of 2011 and it was removed in March 2012. I had to wait six months before having numerous tests to determine if I would be able to have the sleeve. I am happy to say that I passed all those tests. I then had to go through the ordeal of getting approval from my insurance company which I received on the 20th of this month. So it looks like we will be going though this together! What kind of issues were you having with your band? (Congrats on the fantastic weight loss!!!!!!!!) Are you going to be able to convert in one surgery? I couldn't because of the erosion. Of course during the almost year wait I have put back on almost all the weight I lost with the band (95 lbs). You may also want to post in the band to sleeve forum

I have the same insurance and have usually only had to wait a couple of weeks for a response. My understanding is they have 30 days from submission to respond.

I'll try to make this short and sweet I had lap band surgery in February of 2007. I was diagnosed as eroded in November of 2011 and was removed in March of 2012. I elected to switch to a new surgeon to perform the gastric sleeve surgery who required that I wait six months after the removal of my band in order for the scar tissue to heal and the adhesions to settle down. He also required that I have an upper GI, an upper endoscopy and an esophogeal monometry in order to ensure that I would be a good candidate for a high pressure system like the sleeve. I passed all tests with flying colors. I have BCBS-AL. They covered the removal of the band and the subsequent tests mentioned above; however, they have denied my pre-detemination for sleeve surgery until I complete a six month weight loss management program. They stated that since I do not currently have a bariatric procedure that I am essentially having to requalify all over again. Is it me or does this make absolutely no sense at all! Their policy plainly states that they cover repeat surgery as a result of band erosion with no exceptions to that policy listed. We are appealing based on the fact that my surgeon determined that it was medically necessary to perform the revision in two steps and that it would have ben unsafe for me to do otherwise. Has anyone had a similar experience? I feel like I am the only one who has ever had an eroded band and had to wait six months to complete the process. Help!

For those who haven't been following my story............... I was diagnosed with an eroded band in November of 2011 and had it removed in March of 2012. I had to wait for six months before revising to the gastric sleeve as my surgeon wanted to wait for me to heal completely and do medical tests before confirming that I would be a good candidate for the sleeve. I have complete those tests and he was satisfied that I could have the sleeve. We also found that I had developed another hiatal hernia (the first one was repaired when I had my lap band surgery). My predetermination request for the sleeve surgery was denied. They stated that I needed to complete a six month weight loss program in order for them to consider my request. I asked my surgeon's insurance coordinator to appeal based on the reasoning that this was a repeat surgery for a lap band that had medically failed me and that I shouldn't have to complete the six month medically supervised weight loss program. She filed an appeal but no where in the letter did it address the six month weight loss program so of course they denied me again stating that we still hadn't submitted the records they had requested. Frustrated beyond belief, I took the initiative to write my own appeal letter. I used language from the BCBS-AL bariatric policy regarding repeat surgeries and their rationale for requiring the six month weight loss program and explained how I had met that rationale just by having a lap band for four years and that my waiting for six months before revising to another surgery was not conducive to improving my health. I just got off the phone with BCBS-AL and they have approved my surgery!!!!!! I am actually shocked that I succeeded in my appeal. I fully expected them to deny me and had already started the medically supervised six month weight loss program in preparation for that denial (and have lost 10 lbs over a six week period which is nice). I'm excited, relieved and nervous! I've been through this before so I don't know why but I am. I was very successful with my lap band (losing 94 lbs). I remember how wonderful it felt to be thin and feel good about myself and how I looked and not to be in pain anymore from carrying around all this extra weight (yes I packed the pounds back on after my band was removed). I can't wait to be there again! Yeah me!!!!!!!!!!!!!!!!

Jasmine, I sent my own three page appeal letter explaining to BCBS-AL why I shouldn't have to complete the six month weight loss program and they approved my surgery!!!!!!!!!!! Be your own advocate. Write your own appeal letter. I'm a firm believer that most insurance coordinators just go through the motions and will accept anything the insurance companies tell them. If you need a copy of my letter as an example just let me know and I'll send it to you. You shouldn't have to suffer after the band failed you medically.

I hear you Jasmine. I went nuts after my band was removed. It's amazing how quickly the weight comes back. Now I'm miserable and feel the way I did pre-band which is why I don't want to have to wait another six months. The company I work for is in the process of being bought out so there is a very real possibility that I may not be covered in six months. I have started the six month diet (earlier this month) but that puts me into June at the earliest to have my surgery. By then it will have been fifteen months that I will have been without some sort of Bariatric assistance. It just doesn't make sense why the insurance companies would make us do this after already having a band. Why are you revising to the sleeve?

I'll try to make this short and sweet I had lap band surgery in February of 2007. I was diagnosed as eroded in November of 2011 and was removed in March of 2012. I elected to switch to a new surgeon to perform the gastric sleeve surgery who required that I wait six months after the removal of my band in order for the scar tissue to heal and the adhesions to settle down. He also required that I have an upper GI, an upper endoscopy and an esophogeal monometry in order to ensure that I would be a good candidate for a high pressure system like the sleeve. I passed all tests with flying colors. I have BCBS-AL. They covered the removal of the band and the subsequent tests mentioned above; however, they have denied my pre-detemination for sleeve surgery until I complete a six month weight loss management program. They stated that since I do not currently have a bariatric procedure that I am essentially having to requalify all over again. Is it me or does this make absolutely no sense at all! Their policy plainly states that they cover repeat surgery as a result of band erosion with no exceptions to that policy listed. We are appealing based on the fact that my surgeon determined that it was medically necessary to perform the revision in two steps and that it would have ben unsafe for me to do otherwise. Has anyone had a similar experience? I feel like I am the only one who has ever had an eroded band and had to wait six months to complete the process. Help!

This is a letter I wrote to the practice administrator for Dr. Cywes and Dr. Pinnar outlining the many reasons I decided to go with another surgeon even though it will cost me more money and time. I wasn't going to post it publicly, but since they seem inclined to ignore my repeated requests for my medical records, I feel justified in doing so. For what it's worth I do like Dr. Pinnar, but the accumulation of all the issues below finally motivated me to make the change. Dear ******, I am contacting you as the practice administrator to request that all claims submitted to my insurance provider be withdrawn and to outline the reasons for my decision to go with another practice for my surgery. I will apologize in advance as this may be rather lengthy but this has been a difficult decision and one that I have weighed for the past month. On February 7, 2008 I had lap band surgery which was performed by Dr. Cywes. I had considerable success until approximately two years ago when I began to be able to eat more and began to put on more weight. I then went to Dr. Baptista for maintenance fills primarily due to my past experiences of having to wait hours to get in for a fill with Dr. Cywes. It was faster and easier for me to get them done by Dr. Baptista. Last November, Dr. Baptista order an upper GI to check my band and discovered that my band had eroded. This was confirmed by an upper endoscopy in December. It was at this time that I decided I wanted the gastric sleeve but I was not comfortable with Dr. Baptista’s level of experience in this area so I made a call to Dr. Cywes as I felt more comfortable with him with a more complicated surgery. When I called and explained my situation to the person who answered the phone, she placed me on hold and then came back and informed me that Dr. Cywes felt I should have Dr. Baptista perform the surgery. In other words, he was not interested in seeing me since I went to his former partner. At this point, I decided to go to Dr. Webb’s practice to explore this option. When Dr. Webb’s office requested my records from your practice, I subsequently received a call from the office inquiring as to my reasons for pursuing another surgeon. I explained my experience to her and she assured me that Dr. Cywes did not mean that he was not interested in seeing me and that there were options out there that Dr. Cywes would like to speak with me about. She suggested that I come in with no obligation other than to hear what options were available to me and I agreed. After meeting with Dr. Cywes, I agreed to have him do the surgery to remove the band and subsequent repeat surgery. This was on 2/1/2012. It took a month to submit the initial pre-determination request and the subsequent appeal letter as a result of the initial denial by my insurance provider. We received the approval to proceed on 3/1/2012. Due to an issue at Shand’s with Dr. Cywes, I had to schedule the surgery for 3/29/2012 with Dr. Pinnar at Memorial. Everything went smoothly. I liked Dr. Pinnar immediately and felt comfortable with him. On April 6th, I had my post-op follow up appointment with Dr. Cywes in order to remove the abdominal drain that Dr. Pinnar had placed during my surgery. On April 27th (3 weeks later) I had another post-op appointment. In those three weeks I had put on weight due to my lack of restriction and not following the low-carb plan. As is typical for Dr. Cywes, he saw that I had gained weight and he gave me his usual talk about our relationship with food for 15 minutes and when he was done he said that he would need to tighten my band. I then had to inform him that I didn’t have a band. It appears that he hadn’t even looked at my chart prior to coming in. He just assumed that I had been not following the program. When I got back to my office, I wrote ***** and asked that my gastric sleeve surgery be performed by Dr. Pinnar. I am not comfortable having such an invasive and complicated surgery performed by a surgeon who doesn’t bother to read my chart in his office. On May 15th, after repeated attempts to contact ***** to inquire as to the status of filing a claim for surgery with my insurance company, I finally wrote a lengthy email expressing my frustration with the practice, lack of communication and lack of action in filing my claim. I copied you on this email and it is attached. At this point I finally received a response from ***** saying that she was having computer issues and had not been receiving emails. I responded to her expressing that I understood about computer issues and asked when she would file my claim. She wrote me back on May 17th and said she would be filing it that day. The next day (May 18th) **** wrote to me explaining that she had faxed clinical information to my insurance company. She stated that my current BMI was 35.8 and that if I had a BMI under 40 I would require a serious co-morbid condition to get approved for the sleeve. I wrote back to her explaining that since this surgery was a result of an eroded band that I didn’t believe my insurance would require me to have a co-morbidity. I didn’t hear back from ***** until May 25th stating that she had finally filed my claim. On June 1st, I had a follow-up appointment with Dr. Pinnar. Once again, I had gained more weight, but I wasn’t concerned about it as I knew the reasons why. While I was waiting for Dr. Pinnar, the nutritionist came in looking very concerned and asking me what was up? She also asked me if I felt I had sufficient restriction. I explained to her that I didn’t have a band. She then asked if I was a conventional weight loss patient. This was not the first time she had seen me but once again, it was a case of not reviewing a patient’s information before coming into speak with them. I also had a chance to speak with **** and express some of my frustrations and concerns about the filing of my claim. She assured me that she understood and that she would make sure my claim was filed properly (i.e. for a repeat surgery as opposed to a first time surgery). After **** left, I proceeded to wait approximately 45 minutes to see Dr. Pinnar. He knew I was there as I spoke to him when I first came in. I could hear him out in the hallway talking on the phone and waited patiently for him to finish his conversation. I justified that it must be an emergency since he knew I was there and was keeping me waiting. When he finally came in, he apologized and explained that he was on the phone with his attorney. I was aware of the issues he was having with the physician who bought his practice in Virginia and we discussed that matter for a few minutes. Thankfully, he was aware that I had had my band removed due to erosion. Still, I am a very busy woman. I manage the cash for ********** in their Treasury department. My boss depends on me a great deal. I understand that Dr. Pinnar has some serious issues going on, but he needs to address them on his time, not mine. On June 7th, I wrote to ***** to advise her that my insurance company had submitted a reply to their correspondence department stating that in order to approve the surgery for the sleeve I would have to complete a six month weight loss program with my PCP, which is standard for someone having their first bariatric surgery. Since this is a repeat surgery resulting from erosion, I feel that this requirement should be waived. In my email, I reminded her of this and asked her what the next steps would be for my appeal. I wrote again on June 12th and again on June 14th asking what the next steps in the process would be. To date, I have not had a response from her. ****, I hope you can understand my frustration with this process. I am frankly tired of being ignored and having to constantly remind my health care provider of my medical status and hand feed insurance policy language to support my claims. I have registered with another practice and have an initial consult this Friday with them. I would appreciate my records being sent to them as promptly as possible once they submit the request for them. Even though this is going to cost me a considerable sum of money and probably a little more time since I am basically starting over again, I feel I will be more comfortable with a practice who respects my time and communicates with me. I am a very patient person, but my patience has been pushed to the limit.

Hi Pookeyism, My new surgeon suggested that I go directly to the hospital for the operative report and I have done that. Hopefully that's all that he'll need. He is going to be redoing the upper GI, upper endoscopy and also doing an esophageal manometry in three months so the other information will be outdated by then. I have pictures of the original band placement as well as the images and report from the endscopy showing the erosion so he was good with that. I am just annoyed that I asked three times for my records and received no response after being told that if I needed anything to please contact them and wishing me the best. Their actions speak louder than words.

I just had a consult today with a new surgeon in regard to a revision from band to sleeve. I had my eroded band removed three months ago. He told me today that he waits six months after removal in order for the site to completely heal and the scar tissue to form. In three months, I will have an upper GI (to see how much restriction I have), an upper endoscopy (to look at the scar tissue) and a procedure I had never heard of called an Esophageal Motility Study using manometry. This test measures the function of the esophagus to make sure it is working properly. Due to the removal of the band and subsequent scar tissue, it can affect the ability of the esophagus to keep food from coming back up especially with the high pressure that the sleeve creates. This makes complete and total sense to me and I'm sort of surprised my prior surgeon didn't recommend it. I definitely don't want to have to live the rest of my life with acid reflux. He said that scar tissue probably wouldn't keep me from having the surgery, but the function of my esophagus definitely would. Just something new that I learned today that I thought I would pass along.

So BCBS-AL did not require you to do a six month weight loss program or meet the BMI or co-morbidity requirements? Was your original procedure covered by insurance?