HELP!!! Post Op Complication and Costs

Bozav8 · May 27, 2010

My wife has had a band for about 3 years. Just went in for a fill because she's had rapid apetite gain. The band is deflated or partially deflated. We have an immediate appointment today to speak with the surgeon.

My questions:

1. Is there an immediate health issue???

2. Will corrective surgery be covered?

We paid cash as my insurance doesn't cover lap bands. Insurance MAY cover this as it is corrective but I will still have a substantial co-pay. I don't feel I should have to pay anything as we obviously havent gotten what we were promised. Anyone know how this should play out? Should I contact an attorney?

onenuttynurse · May 27, 2010

Oh..you are kind of in a tough spot here....Its called a risk as with any surgery. I would wait and see what has happened. Sounds like a hole is present in the band. They will be able to due it under fluro to see if there are any leaks. Its a tough one because you paid out of pocket, unfortunately as with any surgery, there are really no guarantees. Expecially since its been 3 years. Be patient and See if your insurance will cover it. As for hiring a attorney. What are you wanting to sue them for? That would be a tough thing to prove, and do you want to wait possibly 3 years to settle it. Also, they will go though you with a fine tooth comb before they give you a dime, and if they find one thing that she didnt comply with having this band, then its a no go..Believe me, I can attest to that...I wish you the best and maybe it is something very simple that can be fixed.....onenuttynurse

Bozav8 · May 27, 2010

My main concern right now is if there are any known health risks with what we are seeing?

I understand there are risks with surgery (infection, healing, etc) but this is clearly an issue of a defective band that didn't last as promised. Should defective parts be covered under some kind of guarantee? Original paperwork is at home and I haven't been able to review any clauses but it seems to me that we haven't gotten what we were promised.

I'd only want to go the attorney route to cover replacement costs, not looking for a payday. Just want what I paid for.

Spartan · May 27, 2010

Based upon the description you have given, no, there should NOT be any immediate Health concern in this situation.

As far as what the problem might be, specifically, and what caused it, that is a little more difficult to ascertain. There are several things that could cause what you have described. Your surgeon will be able to tell very quickly what the problem is, and how it occurred.

As far as the other issues, that brings you into the very murky world of insurance, and what they will or will not pay for. I do think that in this case, the insurance will not pay for a repair/replacement, because they did not pay for the original fitting. If it can be demonstrated that it is the fault of the device itself, then you MIGHT be able to recoup your expenses from the Manufacturer… I have seen that happen, but again, it is unlikely, considering that it has been 3 years.

Because you were a self-pay, it is POSSIBLE that the surgeon might replace it, but that is dependant upon what was in your original surgical contract,…..MOST people do not read those, and they would be amazed to see how well the hospitals and surgeons have protected themselves in this regard.

As far as seeing an Attorney, I would wait on that a bit, and see what your insurance company and your surgeon have to say about it. You might have several entities to deal with in this (Surgeon, insurance, Band Manufacturer, hospital) and one of them might offer you an acceptable solution outside of involving the courts.

I am a very strong advocate of following your Surgeon’s pre and post-op protocol TO THE LETTER. And the situation that you are describing is one of the two primary reasons. In the event that you become involved in post-surgery litigation with ANY of the involved entities, you will need to demonstrate that you have followed the Surgeon’s instructions EXACTLY….otherwise, your case will likely be thrown out the door. If the Surgeon says in his/her instructions that you need to be consuming Mushies ONLY for two weeks post-op and you make a Domino’s Run after three days, the Defending entity can make an effective case that what you did undermined the integrity and functionality of the band mechanism, and that can damage your claim. So, patients need to do as their surgeon instructs.

NOTE: I am not suggesting that this is the case in the situation we are discussing….I am using this only to emphasize the importance for ALL Lap Band recipients to follow their surgeons instruction to the LETTER.

Please let us know what happened, when you find out. I will be very interested in knowing if you are able to get any of the involved parties to pay for whatever repair/replacement is required.

S.