Gigi_Girl

I have made two appeals to the review board in this six week period. did your insurance state only one "type" of weight loss procedure in a lifetime? doc and I presented medical issues with the band and the leakage problem. They agreed to revise, but only to band. What on earth did you put into a 57 page appeal?

Pevette and Pookeyism, Yes, I have heard of "upgrading" surgeries from others. In plastics, often insurance will cover a panneculetomy, but surgeons will charge the patient the difference to upgrade. I have hounded the insurance coordinator from a variety of angles attempting to get a price for the difference of the band removal and revision to sleeve. I am more than willing to pay a fair difference. I was told that it was fraud to submit on procedure code to insurance when in fact another was performed. They refuse to do it. Maybe someone with insurance filing experience can explain this to us?

Hi, I saw your old posting. Did you ever get approved? I am going thru that process now with BCBSAL and have received two denials due to once in a lifetime benefit. Nevermind, the darn band has a leak! Anything from your experiences that you can share would be appreciated. Gigi

I don't know what the percentage of band to sleeve revisions are, but I agree that your choice to start with a sleeve is best. As for the seminars, usually, whichever doc does the program is who you sign up for. They are both good. I haven't been to the support group in several months. Mainly because of my band issues. I didn't feel I would be a good spokesperson until I get resolution....band out, change to sleeve, etc. I am going to call my insurance again this afternoon to check on the status of the revision. I never have been a patient camper.

Mary, I have been thinking of you. So glad that you are well enough to be home!

Sounds like some minor ailments. Congrats to you for gettng sleeved! How long will you be in the hospital?

So glad it is nothing too serious. Glad you are feeling better!

Sorry you are not feeling well. Are you back home or in Mexico?

Hello! Welcome! I use Dr. Miles from the same group. You will find them both to be very capable doctors. I am in limbo waiting for a band to sleeve revision. I have insurance approval to remove the band due to leakage and gastritis, but they are not wanted to replace with the sleeve. Hopefully I will have an answer from BCBSAL soon. The 7-month wait is frustrating, but you will find that it goes by quicker than you think it will. Just follow all of the doc's directions.

I love Sobe and Propel vitamin waters. They are my new sodas. I don't even miss soft drinks.

aldmb2, just curious, on what grounds did they turn you down? (I am still in a holding pattern waiting on my approval...or not)

I take Bariatric Advantage chewables: multi-vitamin, calcium, and iron.

missmeow, you refer to short term memory loss. I have not heard of this. Can you give us a research link? Is it due to anesthesia or something with the procedure itself?

Wow! I am so proud of you! Great job! Keep us posted.

Carbgrl, you are doing great! That is very encouraging to me!

I am in the process of requesting approval for a revision. What kinds of questions do you have? Gigi

BCBS has approved removal of may band due to medical problems! Yeh, I am halfway there. But...they denied the revision to a sleeve stating insurance covers on one weight loss procedure in a lifetime. I am in the process of composing a request asking review of predetermination to pay for the sleeve. I have composed a two page letter covering all the medical issues and leaking band, etc. and have closed with the following three paragraphs. I welcome your suggestions for improvement. I plan to mail Saturday. ________________________________ The band is leaking and defective. Would a product failure through no fault of my own not be reason enough to replace the band with another restrictive method? BCBSAL states that revision of adjustable gastric restrictive devices meets BCBSAL’s medical criteria for coverage provided there is either a band erosion or slippage, or infection around the port site. Would it not also be appropriate to revise due to a device failure? The lack of proper fill levels has impacted my weight loss. Unfortunately, with the band failure, my weight is creeping up and I have gained 25 pounds from my low weight over the last 18 months. I am compliant in knowing what things I can and cannot eat and drink and I do Zumba several times a week and I walk. But without restriction, weight will inevitable continue to reappear. If I gain much more weight, Sleep Apnea will likely return and I will be put back on a CPAP. Thank you for understanding and approving the band removal to alleviate my medical issues, but please reconsider my request that my defective band be revised to a sleeve without further delay. All I want is to repair the damage done by the failed band and to restore the gastric restriction that I was originally approved for. Please help me bring this predetermination to a quick and satisfactory conclusion.

Thanks for everyone's comments and well wishes. Keep your fingers crossed!

FIXDF2008, Sorry you had erosion problems. Dealing with insurance is always so frustrating. Hopefully, you will get good news soon. I just put up another post regarding my journey requesting band to sleeve. Take a look. Gigi

I am attempting to get my insurance carrier to pay band to sleeve revision due to a leak in my band system. If you had a defective or failed band, what portion of the revision did your insurance cover? By the way, my BMI is 35. Gigi

Any using Drs. Miles or Schmitt in Birmingham, AL? I would like to get a group discussion going.

Vicki, you mentioned staying at the Hampton. Did you have tests the next AM or just office visit to follow-up? I am thinking since I am an hour and a half away from St Vincent's East, that staying overnight locally would certainly be better than coming home.

Good point, kmoore. Thanks for your well wishes.I hope Furby gets a quick YES answer soon too.

Furby, I am in the same boat as you. I have been calling weekly. Someone else suggested to me to call every three days. I know we are all anxious for the news, but I think there is a balance to consider. After all, if we keep them tied up, how can they review our files and others? Maybe a compromise of every 5 calendar days? Good luck to you and hope time passes quickly for you! Gigi

Wow! 30 lbs in 2 weeks is awesome! Was your sleeve your first surgery or a revision? Was your procedure inpatient or outpatient?Gigi