mdonahue4688

Hello Everyone, Was looking for some insight. I have been having weight gain and some left side pain and have found out that my lapband tubing is disconnected and there has been a slip, I'm most likely going to convert. Does anyone know what aetna requires before a conversion? Thank you!

@Deedee12Thank you! I don't know quite who to talk to @ Aetna, I was thinking a case manager may be able to help me. I too would just barely meet criteria if just applying for a sleeve as I am just obese, have no co-morbidities. In the clinical policy bulltetin there are options A-D for repeat bariatric surgery and all of them require "compliance" with diet and exercise program which is hard to show because when I was successful I did not frequently see a doctor for my band. I started seeing a doctor when my reflux started and i started gaining weight. My doctor prefers to do the removal and revision in 2 different surgeries but if there is no complications will do it all in one. My fear is that if i Just get the lapband removed I will be denied for a sleeve. Even without the "compliance records" I feel like with the damaged lapband evidenced by xray and the reflux and weight gain I should be approved for a revision---I feel that with all the research and data out about lapband complications insurance suggesting another band or a band fix is ridiculous! The person at my doctors office just keeps saying this may be tricky, I want to know from someone at the insurance company what I need to submit exactly to be approved. I have a POS II policy. I don't know who to talk to there or where to start and would like to speak to someone before submission because I know a denial can be difficult to fight. I am also choosing to go out of network because the previous physician I had seen did not catch all the problems visible on Xray with my band. I appreciate all of your advice, thank you! If you have any other suggestions I would appreciate it! Thanks! Maura

@Deedee12, the clinical policy for this states for revision approval you need to show compliance with diet and exercise...how did you do that? When I was successful with the band I didn't go to the Dr. very often, and prior to going to see the Dr. who will be doing my revision I hadn't seen someone for my band in almost 1.5 years so I'm nervous I'll get denied despite having tubing that is disconnected, a mispositioned port, and a slipped band. Thanks!

I was banded 4/2012, since i have lost approximately 35 pounds. The last 2 months, not a pound. I have had two small fills however I NEVER feel full, I only get stuck. Recently I have been eating more than I know I should be able to. I am also exercising. I have a fill scheduled for 1/17/13 but I need some help getting back on the success train. I am praying my weight loss doesn't stop here.

Thank you everyone for your encouragement and suggestions!

@ Lee...I am an er nurse...I work 3p-3a, i must admit my sleep is not the greatest. Sometimes it comes between sleep and exercise. Usually when i am at the gym on my own time I do cardio for about 30 mintues on treadmill or eliptical and then light weight training. If I am with my trainer we usually focus on core strength, balance, endurance, and weights.

I was told by my surgeon/coordinator that i need to be off of contraceptives for 12 weeks! I want to do everything by the books, but is that necessary? I got the depo shot every 3 months before surgery and plan on returning to that asap, i am just wondering how soon i can get a shot. If my gyne says it is ok to get before the 12 weeks should i proceed?