ERNJN

First time starting a thread -- a long time coming! My lap band journey began just before my Senior year of college back in December 2008, I have a dense family history of morbid obesity and was finding myself headed in the same direction tipping the scales at 240 lbs my Junior year of college (I'm only 5'2"). I opted for lap band as I was young, worried about a permanent procedure, and excited to be able to control my restriction. My lowest weight was 135 lbs and although I definitely wasn't always good to my band, I found it to be an overall positive experience and certainly life changing. There are so many things I was able to do, feel and experience because of my weight loss at such a pivotal time in my life. At times I've wondered what the fate of my band would be but as the years went by the restriction and presence of my band became a part of me (UNTIL IT ACTUALLY BECAME A PART OF ME...lol...read on). The only major side effect besides the occasion "stuck" incident was debilitating gas pain. I would get gas so bad I'd become totally bloated and doubled over, but like the band, I learned to live with these episodes...and stopped eating Beans altogether. Three months ago I began to feel a faint "airyness" in my tummy, similar to the gnawing sensation that you might feel with an ulcer (I'm guessing). It wasn't painful but a noticeable difference. As weeks went on, other symptoms began to appear -- two or three isolated feelings of nausea, slight chest tightness/esophagus pain, slight heartburn (never acid in the throat though), upper back pains, NEW pain when food passed through the band, and as a result of all of these: randomly rapid heart rate! I've come to believe the heart rate was anxiety and/or my bodies' reaction to these symptoms. I knew it was time to get some tests done... After a visit to my surgeon and near-perfect upper GI (no slip), we took all of the saline out of the band (I had been at the same restriction for a good while) and waited to see if symptoms improved. A few did, a few did not. I began to wonder if it was even band-related or maybe just new stress-related gastro issues. Needless to say I was falling down a deep, scary WebMD hole of worry. I made an appointment with a wonderful gastroenterologist to rule out other causes, he had me get an ultrasound and endoscopy. Ultrasound: perfect! Wonderfully placed organs. Then finally the Endoscopy: your band has eroded! Yep. Lap Band erosion, there it was, poking through my tummy. It wasn't as severe looking as some I've seen so I'm hoping/thinking it hasn't been like that for too long. After the test results I immediately went into see one of my two phenomenal surgeons (both have been practicing bariatric surgery as a team for years - they are amazing humans). He said there was definitely a hole in my tummy and that both the band would need to come out and that my tummy would need to be repaired. He assured me that although I had been maintaining at 165-170 lbs, I would surely gain the weight back once the band was removed. So he offered to revise to a sleeve -- basically free of charge. He concluded that because I would need repair anyways, they might as well just take a bigger chunk out of me. Although, I wasn't quite ready for the conversion, I trust my surgeons and knew that my insurance would not cover a sleeve down the road. My brother and aunt have both had the sleeve with great results and I started remembering where I was when I had first elected to get the band -- I would love to avoid going back to that weight. In the back of my mind though, I wondered if it might be a fight with insurance for "band removal," low and behold -- IT IS. Although I am on track to get the surgery on April 26th, insurance has already messed everything up. HELP! Questions... 1) My insurance (which is supposedly AMAZING) doesn't cover ANYTHING related to bariatric surgery or weight loss (ugh). Not removal, not fills, nothin! However, there is a hole in my stomach. As the doctors have said, this is not a sustainable situation. If I don't get it fixed now, I will end up in the ER. Today, I received the initial denial letter. Has anyone else found themselves in this situation? I'm not "electing" to have the band removed -- IT JUST NEEDS TO COME OUT, my stomach has a damn hole in it! 2) My surgeon seems confident in a one-stage revision. In fact, both of my skilled surgeons will be performing the procedure. Has anyone else with erosion done a one-stage revision? How'd it go? Any help is much appreciated and thanks for reading my long-winded story. These forums have been a real help as I've gone through these many symptoms. Currently, the only real pain I'm experiencing is sometimes when eating, intermittent back pains, and at night -- hoping it doesn't get worse before surgery... Cheers!

@@Susiequs -- What ended up happening with this? I am in the EXACT same boat except my band has eroded so once they remove the band they will need to repair the hole in my stomach. I was covered initially -- got the surgery based on medical necessity and it was fully covered under my old insurance. My current insurance does not cover bariatric surgery but due to the erosion, it is critical to my health that I have the band removed and my stomach repaired. I received the initial denial and we are now appealing. I'm hoping your daughter's outcome was positive!

Looking for any help or experience with this issue! The pre-approval for the removal of my lap band has been denied as Bariatric Surgery (revisions, fills, etc.) is completely excluded from my insurance plan. So I suppose the initial denial is not surprising. However, my stomach has a hole in it. This will eventually escalate into an emergency-ER situation -- wouldn't insurance agree to cover in this case? Has anyone had luck with an appeal even though all Bariatric-related procedures are excluded in your plan? If there's hole in my stomach, does this not turn into something different? Any help or advice on appeal-writing is appreciated. My surgeon has a peer-to-peer scheduled for tomorrow, if that fails, I will submit the first appeal. THANK YOU!

@@Luckeydoo -- I would love to discuss further! I'm unsure of how much of the band has eroded, going off of the photos and limited medical expertise I would say 25% percent is peaking through. Neither my gastroenterologist or my surgeons have commented on the timing for getting it removed, only that it was not a sustainable situation and needed to come out. I will self pay/take out a loan before it becomes an emergency room situation because of exactly what you went through, just more costly in the end. I'm sticking to my April 26th surgery date no matter what! I will DM you now -- thanks!

Sorry to hear about the infection post-op, Sue. I'm also having my band removed due to erosion in April -- I'm worried about the recovery as the surgeon is going to convert me to a sleeve. Is it standard to recommend 6 mo. healing before the sleeve procedure is done? My surgeon seemed confident in doing it all at once.