rccbrandon

I was denied because BCBS said the revision wasn't medically necessary. I've had the Psych, and the Cardiology, and I'm going for the sleep medicine MD tomorrow. BCBS also stated that they only cover 1 bariatric procedure per lifetime, though my MD office said they've seen that reversed. I'm getting even more frustrated because since I had to have all the fill removed from my band, I've gained like 30 pounds back. The best part is, that my eating habits are better now (not eating as much junk) than when the band was filled and I've gained so much weight back.

I am hoping that someone here might have had a similar experience as me and can give me some pointers. I had my lap band surgery in April, 2008. I did fairly well in the beginning and lost a majority of my weight in the first 2-3 years. Since then, I've yoyo'd within a few pounds. I went regularly for adjustments but got close to the max for my band and started having problems eating. There wasn't really a meal where some part of it didn't come back up (my lap band folks know what I mean). I got sick (Bronchitis) back in December and went to see my PCP and talked about my unhappiness with my overall results. She referred me to a surgeon at a different hospital who was doing a lot of revisions. I went to see him in early January and told him about all the problems I was having. He sent me for a swallow study and determined that my band was inflated too much. At my next appointment, he removed all the fill and now I have almost 0 restriction. In the midst of all this, the office submitted to my surgeon to see if my insurance would cover my revision. Like I mentioned earlier, I didn't lose all that much weight. My surgeon is from Europe, where they have been doing lap band longer than in the US, and there is has been found not to have good long term results. My current surgeon isn't even doing the lap band anymore for this reason. Long story short, my initial pre-certification was denied and my initial appeal was denied. I didn't go through all the pre-op appointments I (I did cardiology and psychiatrist) because I didn't want to do them all if I was going to be denied, but now am wondering if there wasn't enough ammo for insurance to pay for revision. I had Keystone when I had the initial surgery and am back to Independence Blue Cross (PPO) (the same insurance company) and that is probably the reason I'm being denied. My BMI is still over 40, and am getting even more discouraged due to having gained back a nice amount of weight. I'm about to file the 2nd level appeal. Has anyone gone through this and had decision reversed? What did you say during 2nd appeal. I'm looking for guidance from anyone who may have gone through the same thing. Thanks!!!!

I went in for my fill on Monday morning and was taken from 4cc to 5.5cc's (I have the 14cc band). I was fine the first 2 days eating soup and mushy stuff. On the 3rd day I attempted to eat scrambled eggs and had throw them up. I thought it may have been the toast I was trying to eat with it, so I tried the eggs alone the next day only to have the same result. Long story short, I kept throwing things up over the next few days. Today I finally called the surgeons office and they said to come right in. When I got there I was weighed and I lost 7 lbs in 5 days. They unfilled me back to 4 again. Now I'm slightly afraid about getting filled again. Am I going to have the same problem next time? Has this happened to anyone else?