Search the Community

I have been denied coverage from BCBS insurance company for requesting lapband to bypass revision. Because they can find nothing wrong with my band, they won’t do the surgery. Even though the band is okay, I’m not. It has caused esophageal dilation and dysmotility. I lost weight with the band but I was vomiting a lot at night. Id wake up from a dead sleep vomiting out of my nose and mouth at least three nights a week. Very scary due to possibly getting that into my lungs. Has anyone else filed an appeal that was accepted by insurance?

I'm doing okay. I have lost 40 pounds. I am a revision surgery from band to sleeve. I have had some beers and some cocktails recently and also have cheated a few times on my food plan but I ate in smaller amounts than I would have. I'd like to drop another 20 pounds but I'm fitting into a lot of my skinny clothes again so that's encouraging. I try to walk 10,000 steps five times per week.

Great job this week everyone!! Last week 288 This week 282 -6lbs Holy crap haven't seen numbers like that in a long time!! Was SO thrilled!! Really been going hard I'm SO happy with this number! Only 2 pounds until my V day goal of 280, when and if I get there before V day (If this losing streak continues which I sure hope it does!) I'll revise my goal

Congrats on your wl, you are doing great. I’m 7 months post bariatric revision and have lost 79lbs to date. I’m officially stalling been 180-181 for almost 3 weeks now. This is longest stall I’ve had and starting to wonder if I’m done losing?? Got a couple more months to go to reach a year and my projected wl is 100lbs.. I hope this stall breaks this week!!!

Day 8 post-op update, band to sleeve revision on 8/19. Feeling better every day. The first 5 days were so hard. I knew they would be hard, but it was so much worse than I anticipated. Not at all like my band surgery, more like my bad c-section 13 years ago. One thing I had not expected was the anxiety, I was terrified the whole first week that I was going to have a bad complication and have to go back into the hospital for months. Surgery was Monday, Friday afternoon I turned a corner and started feeling better. Now every day is noticeably better, drinking more, walking further and easier, moving better, less pain and less anxiety. I finally have some hope for the future! Keeping all my fellow August sleeve buddies in my thoughts and prayers for successfull surgeries and recoveries!

I had a sleeve done in 2015. My revision to bypass is on 19th sept. I have developed something similar to a stricture and worsening nausea when i eat. I'm glad you posted this because I'm really interested in hearing about other people's experiences too. Sent from my SM-G950F using BariatricPal mobile app

I am tomorrow, August 7th. Today is the 2 year anniversary of my wife's surgery. She had lost so much weight before on Weight Watchers, and put it back on, that I thought she should just go that route again. So I was against bariatric surgery. She had a lap band for 4 years and was miserable, so she had the VSG revision. She's become an Iron Lady. She does kettlebell, which I introduced her to 3 years ago, marathons, mud run obstacle courses. Its time for me to catch up.

It can be due to the stress of the surgery and may have nothing to do with protein. My doc said if it's going to fall out, its going to fall out. My hair fell out when in had the lap band two years ago and started growing back after three months of losing it. Now I am almost three months post revision and can see my hair is beginning to fall out again, but I'm not worried because I know it will cone back.

Hello all! Please add me to your group! I'm a band to bypass revision. Just got my date for March 21st! So Glad to have found all of you!

Hey all! I will be revised from my sleeve to gastric bypass on July 20th due to a pretty large hiatal hernia as well as gerd.. I have lost about 70 pounds and I am over a year out from the first surgery. I have heard the weight loss is slower the second time around and I am just curious on what the weight loss has been for others in a revision. Would love any feedback on weight loss!

Im getting most in without issue the soup helps to mix up No heartburn obe weekout second revision

Band broke after 10 years went from 12stone to 16stone had op cant lose weight 16.3 spent £6000 feel a failure had abroad need help support wish got another band gutted Heather from Scotland op in latvia too expensive here Sent from my SM-G960F using BariatricPal mobile app

I'm so sorry you are going through this. It sounds terrifying and painful. I had a revision from vsg to rny in August. My recovery was same or easier than with the vsg. I chewed Mylanta mini tabs to get rid of the excess gas after surgery. Physically, I don't feel different either except that my appetite is much less after RNY. All my issues were resolved after the revision (acid reflux, hunger problems... Etc.). I don't have any issues anymore, not bowel related or stomach related. So far (knock on wood ^^), it has been the best decision I've ever made concerning WLS.

I am not even a year out and have only been able to lose 1-2lbs a month for the last 8 months. However in lost and regaid120lbs and the doctors believe the sleeve didn't do enough and are suggesting I go in for a revision to the full gastric once I hit my year mark, which I plan to do seeing as I have a minimum of 67lbs to lose..

Hi. I am 57 thinking about revision to bypass from band. Many probs. how are you doing?

I am 57 having revision from band to rny tomorrow. Hope to have some healthy years in this second half of my life.

http://mcgs.bcbsfl.com/ Note the timeline on this: 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows: <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested. Gastric surgical procedures for the treatment of clinically severe obesity include: <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band. WHEN SERVICES ARE COVERED: Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language. NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director. Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met: The member: <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months <LI class=bulletedList-1>has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention; does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder). The following procedures may be considered medically necessary when the above criteria has been met: Vertical-Banded Gastroplasty (CPT code 43842) Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. Roux-en-Y Gastric Bypass (CPT code 43644, 43846) Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include iron deficiency anemia, vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach. Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774) Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows: "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives." Biliopancreatic Bypass with Duodenal Switch (43845) The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment). WHEN SERVICES ARE NOT COVERED: Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits. Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity: Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847) Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. This procedure consists of the following components: <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant. Mini-Gastric Bypass (no specific CPT code) Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used. NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass. The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes: <LI class=bulletedList-1>jejunoileal bypass <LI class=bulletedList-1>gastric wrapping Garren-Edwards gastric bubble. BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9 Diagnoses Codes That Support Medical Necessity: 278.01 Morbid obesity REIMBURSEMENT INFORMATION: Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS: Federal Employee Program (FEP): Follow FEP guidelines. State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS: Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum. Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity. Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume. Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion). Gastric bubble: see definition of Garren-Edwards gastric bubble. Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine. Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater. Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES: Gastric Bypass Revision, 02-40000-11 OTHER: Other index terms for gastric surgery: Adjustable gastric banding Bariatric surgery Gastric bypass surgery Lap-Band System Mini gastric bypass Billroth II Long limb gastric bypass Roux-en-Y Scopinaro Vertical banding REFERENCES: <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition) U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01 COMMITTEE APPROVAL: This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION: 10/15/99 Medical Coverage Guideline developed. 09/15/01 Various revisions. 01/01/02 Coding changes. 10/15/02 Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services. 05/15/03 Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria. 09/15/03 Coverage criteria for psychological testing/counseling revised. 10/15/03 Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm. 01/01/04 Annual HCPCS coding update. 04/01/04 2nd Quarter HCPCS coding update; added S2082 and S2083. 07/15/04 Scheduled review; no changes. 01/01/05 HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085. 05/15/05 Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged. 01/01/06 Annual HCPCS coding update (added 43770-43774; deleted S2082). 04/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references. 05/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older. Private Property of Blue Cross and Blue Shield of Florida. This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

Originally Posted by Lap_dancer From BCBS Association (corporate) . 5. The improvement must be attainable outside the investigational settings. The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs. Based on the above, laparoscopic gastric bypass meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. http://www.bcbs.com/betterknowledge/.../20/20_15.html Source found at above website. Yeah, but isn't this just for gastric bypass? I couldn't find anything about gastric banding in this document. JB .................................................................................................. Airman, think of doing searches on this subject like a crossword puzzle. Just because you have a th_ _ K doesn't mean the word is think. You won't find some of the information easily. You should keep track of your searches via your search engine history. Book mark things, reduce the screen and open up another window to continue a new search. Open WORD and copy and paste links and language from documents. ( I do this all the time when I am researching). I'm not an insurance agent but here is what I have learned about Blue Cross and Blue Shield. Blue Cross and Blue Shield (BCBS) is like a mall. Inside the mall you have different stores that you can shop from. So you get Blue Cross, Blue Shield, Blue, Blue Options, ... Google is a good friend. Please utilize this in your efforts to gain information available to you. Google entry from me was: BCBS South Carolina weight loss surgery HITS: Suburban Surgical Care Specialists, S.C. - Bariatric Surgery Vanderbilt Center for Surgical Weight Loss, Exclusion List The Next Step for Weight-Loss Surgery Blue Distinction Centers for Bariatric Surgery That one sounds good, I think I'll try it......... (thinking, if BCBS doesn't cover it and thinks Lap Band is experimental, I won't find a hit on my search ) Inside this HIT I see it is the BCBS site, I'l go to SEARCH and type in GASTRIC HIT: Displaying results 1 - 5 of 5 items found. 1. TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity (Web Page; Thu Jan 25 15:43:00 EST 2007) EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures,... Description: Laparoscopic Adjustable Gastric Banding for Morbid Obesity 2. Laparoscopic Gastric Bypass Surgery for Morbid Obesity (Web Page; Mon Oct 30 15:26:00 EST 2006) Assessment ProgramVolume 20, No. 15 February 2006Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net... Description: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. 3. Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass (Web Page; Mon Oct 30 15:27:00 EST 2006) Assessment ProgramVolume 20, No. 5 August 2005Executive Summary Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities.... Description: Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities. HIT: TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass is the most common procedure performed in the U.S., and offers the most favorable benefit/risk ratio among established procedures. Laparoscopic adjustable gastric banding (LAGB) is an alternative technique that has the potential advantages of being less invasive and reversible. Prior TEC Assessments have concluded that LAGB does not meet the TEC criteria. Objective: To review the available evidence on whether LAGB results in similar improvements in health outcomes as does open or laparoscopic gastric bypass (GBY). Search strategy: MEDLINE search for the period of 1980 through September 2006, supplemented by hand search of bibliographies and search of Cochrane database. This goes on but it tells me that they are NOT calling it "investigational." PRINT AND SAVE 1. The technology must have final approval from the appropriate governmental regulatory bodies. Bariatric surgery itself is a procedure and is not subject to U.S. food and Drug Administration (FDA) regulations. However, certain devices that may be used as part of the procedure may be subject to FDA approval. The Lap-Band® system received premarket application (PMA) approval by the FDA in June 2001 for use in morbidly obese patients. 2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes. The evidence is sufficient to permit conclusions concerning the short-term safety and efficacy of LAGB in comparison with GBY. Weight loss at 1 year following LAGB is substantial, in the range of 40% EWL, although less than that seen following GBY. The short-term complications of LAGB are very low, with serious short-term complications being uncommon, and mortality exceedingly rare. Rates of short-term adverse events, including serious procedural complications and mortality, are lower for LAGB compared with GBY. Same page, further on down the page. Airwayman, I could truthfully sit here for the next span of time and do this research for you but in the end, it teaches you nothing on perserverance. I am a teacher. I teach my students that perserverance pays off. In the frustration of learning, there is victory in the end. *I began my own Quest knowing NOTHING about the surgery, my own insurance plan nor how the process works. After six months, I can answer pretty much any question thrown my way. Tomorrow I will get my chance to educate the insurance committee at work. They were told "gastric surgery is not covered by Blue Cross", I beg to differ. http://mcgs.bcbsfl.com/ Search: Medical Coverage Guidelines BCBS HIT: 1.(61.06% Relevant)Gastric Electrical Stimulation... peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling 64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver 0155T Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature ...2.(59.05% Relevant)Gastric Bypass Revision... gastrectomy or intestine resection; with vagotomy 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only 43887 Gastric restrictive procedure, open; removal of subcutaneous port component only 43888 Gastric restrictive procedure, open; removal and replacement of ...>>3.(58.83% Relevant)Surgery for Clinically Severe Obesity... or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the ... 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION. Non-Covered Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines Other References Updates DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows:

There is also another VERY RARE cause, that unfortutenly I experienced. Everytime they filled my band and got to a place of good restriction (about 8cc out of 10cc band) I would experience nighttime vomiting and although I was restricted I could still eat WAY more then I should have been able to and gaining fast.. Each time they took an esphogram and it showed massive dilation. After 6 months of going through the fill/unill cycle they realized there had 2 be something wrong and when they did a revision surgery turns out scar tissue had formed and pulled the band into a malposition. Essentially everytime they filled to a point it would kink off my espogus so all the food would just sit there. Cort http://thebandit1.blogspot.com/

I'm sorry this has happened to you. I have BCBS, too, and struggled trying to understand my benefits. I my started this process in July 2009 and was denied the first time in December 2009 because my "documentation of physician supervised weight loss efforts did not demonstrate that attempt was made over a sufficient period of time." My policy required documentation for two years. My medical records showed far more than a two year history of weight loss efforts, so I called my insurance company to get clarification concerning exactly what I needed to do to be approved; it was difficult to get a clear answer. The woman I spoke to on the phone was very nice, but I could tell she became annoyed by all of my questions. I finally asked to speak with her supervisor because the answers I had received were vague at best. I almost gave up. However, in February 2010, I started regular visits at my doctor's office. During each visit, we specifically discussed in detail my weight loss efforts. The two year time period actually passed by more quickly than I thought it would. My final visit was on February 13, 2012. The insurance company received my paperwork on February 15; I was approved on February 17 and received my approval letter on February 21. Interestingly, when I first started the process in 2009, a 35 BMI with a co-morbidity was required, but the medical policy was revised in September 2011 and required a 30 BMI with a co-morbidity. Be persistent and hopefully, you will receive your approval soon.

Janet, my surgery date isn't until Nov. 30. I no longer have a uterus or cervix, so mine is just like an inside out sock (as the doc says). When they do the procedure, the bladder will be put back where it belongs and hopefully work on the rectum issues as well The paper is not going well. Instead of just writing and THEN revising, I am finding myself over stressing and analyzing every word. I need to stop. Phyl, I glad Earl is getting his nasal issues taken care of. Is this something Earl knew about or is this the first time a doc actually looked at the issue? Janet, I hope that Andrew's appartment works for him. It is time for him to try his own place. You both will have fun setting him up for the first time. Linda, hang in there! Phyl, maybe you need to call the doc's office and tell them that you are in so much pain that you need to see them earlier. It is worth a try. Candic...you home yet? Well best get back to it!

Karri We love you - you are one of us... You came home cuz you have a problem and that's what we are is home.. Promise no tough love ;0) Hugs on the slip - Of course the new doc doesn't want you to go to mexico - that's what all american doc's are going to say ;0) - But I know alot of pple who have gone - Little miss diva (irene) went - she went to the same doc as Wasa ... If I had to have a revision - my insurance wouldn't pay cuz of my bmi - I think they might replace the band - but not sure WLS is even covered under my Aetna policy.. We understand and we are here for you... I have read that unfills sometimes make the band go back into place - Liquids for 2 weeks - ugh that's going to be tough - but you are strong and if you make your mind up - I know you can do it - cuz you are a strong woman.

Yes...they pay pretty crappy. I took a 20000$ pay cut to come here. The Texas weather has been nuts. We are supposed to get freezing rain, sleet and 3-5 inches of snow tonight. I'm really hoping the weatherman is RIGHT! Well the doctor today was pretty convinced he could get my revision to bypass covered by insurance. He doesn't a different type of RNY that doesn't lead to as much malabsorption (it's a new technique in the last 3 years). He spent a long time talking about the complications with the band. I was shocked at how much he said that I realized I had. I won't go into it here because if people aren't having issues than I'm not going to bring up negatives. Just one piece of advice...if you PB...makes sure you brush your teeth. A recent article in a dentistry journal is showing that bandsters have a HIGH rate of tooth decay (along the same lines as bulemia). Never thought about that at all!! I think that if he can get it, I am going to go through with the bypass. It has the most research, history, and longevity studies. In three years I don't want to be hearing about problems with the sleeve and end up with a revision again. However if insurance doesn't cover it I will end up with a revision to a sleeve just because it is cheaper. Well I need to go to bed in case I actually do have to go †o work tomorrow.

I was diagnosed with endo at age 20 now 35. I have had 4 surgeries for endo, I am getting a revision from the band to VGS on June 4th. My lifesaver dealing with endo pain is a magic little pill amitryptaline can knock some people out but man this is the only thing that kills the cramps! Email me if you have any questions endo is a crazy thing!!

Yes I'm a real person and yes I am/was a patient of Dr. Aceves. The reason I felt it was a good choice and safe was that a few of my long time lap band friends had gone to Dr. Aceves to have the revision done. I trusted their stories and recommendations. It did take me awhile to finally take that step (as it is a scary one) and do it. Now I'm 9 months out down 90 Lbs and feeling amazing. Only about 25 to goal and working my way into size 6 - when I started a size 24W. I even used to wear a *tight* size 28W at my highest weight ever. Life's Good!!!