beesam

Hi everyone.. I haven't been here for quite awhile, but I am now seriously considering revision surgery from my second llap-band to sleeve. My first band was put in in 2006. I initially lost 35 pounds but then plateaued there for years. In 2014, I had that band removed becauyse of band slippage and a new band was put in. Since then, I haven't lost any weight at all, and have gained about 15 pounds in all. My question is one of approval. Has anyone had experience with insurance for band-to sleeve revision with a BMI of under 35? I also have co-mobidities of severe sleep apnea, high blood pressure & triglycerides, and now my doctor is concerned with my latest sugar level over a three month span. Since my BMI is only 31, I anticipate a fight with my insurance carrier. Hopefully I may be able to get a revision based upon lap band failure. There is a clause that says if no significant weight loss is achieved with banding, it is considered a failed procedure. I have an appt with surgeon who did 2nd band on May 24. I want to be as prepared as possible. Anyone here in a similar place with revision approval? Thanks so much!!!

I had a band in 2006. Lost about 40 pounds and was doing ok with it. Bnad slipped in 2014. Was removed and rebanded Jan 2014. I Ive had nothing but misery with 2nd band! Gained almost 15 pounds since 2014. Nausea, food getting stuck, port pinching. Im going for consult to revise from band to sleeve. My current BMI is only 31 though. Wondering if insurance will decline? Im now pre-diabetic, along with severe sleep apnea and other comorbidities that qualified me for the band to begin with. Did you experience any problems with approval?

i also found this info from them, but via email. I'm waiting for my surgeon to come back from vacation to get them to advocate for me. thanks for the info and please let me know how you make out. My surgery was scheduled for 12/8, and still is, but denial came thru 11/20, so surgery is in serious jeopardy.

the comorbidities are very tricky. i have high bp and cholesterol, but i take medication, and since they are controoled, they no longer qualify as comorbidities. Most insurers abide by a report called the Betsy Lehman Report, and base their medically necessary decisions on the criteria listed in that report. you can find it online if you google it. do yourself a huge faovor and triple-check your eligibility. Ive gone thru the entire program, including pre-op medical tests, everything-,and was denied 10 days before my surgery.

I'm crushed!! I've gone thru 4 mos. of behavioral classes, lectures, physicals, psychs, and pre-op tests have all been completed, and two weeks before my surgery bcbsMA denied me because of medically necessity. Letter of intent sent to them in early October, and denial just came thru after completing entire program!! I have a bmi of 36, with hbp, cholesterol, possible sleep apnea, (sleep test pending). I just don't understand on what basis I can appeal this decision as a lay person. My surgeon's program secretary said the appeal is my job. Anyone have this experience? To get this far and have it end just like that is too much.

thanks so much for the support. I'm waiting for everyone to come back from holiday weekend to start pounding away at whatever I can to get this done.

I can't believe WW would sanction a group like that!!! Aren't they also supposed to be built on the premise of support and empathy???? You made the right choice.

Hi Everyone.. I'm just beginning this process, and I'm here to get as much info as I can. I'm just starting my million-appointments thing, and have not yet been scheduled for surgery. Hoping for late November/December. One question I have-I have a physical job, and I'm concerned about being able to take in enough to keep me going in the weeks following surgery. Any comments on how you feel 1,2,3 weeks out? Thanks everyone..........