Long term success and insurance question

[missjoli 0]

I've read and heard a lot of stories of people having to have the band removed after 4-6 years. I'm so concerned about getting the band, having great success, and then having to have it taken out. Is there any research out there? Where can I read more about this? Or is there anyone here that can offer any info? Thanks!

Part 2: I have United Healthcare. I called them and they said if you have a BMI 40 or over then it's covered, and you just have to be sure and do some step prior to surgery (alert them?), but that there did not need to be any comorbidities or any other stipulations. They also informed me of my out of pocket max, where we stood with that, and so on. But the Surgeons office sent some sort of request for coverage and it came back that my insurance would need me to do 6 months of dieting under the care of a physician and have a psych (which I'm fine with). But if I'm being honest I was hoping to bypass the 6 month nonsense when I've been losing and gaining for 13 years. They said if I didn't have any documenation of diets over the last 2 years then I would need to do the 6 month thing. Well I've been pregnant and breastfeeding for nearly 4 years so I've really only seen my OBGYN. Anyway, the girl at the surgeons office said sometimes they can resubmit everythning once I've met with the surgeon (tomorrow), and they will approve it without all of the other nonsense. Has this happened to anyone?

[lizzy2150 3]

I can't speak to the first part of the question, but I can tell you my experience with insurance (I have BCBS of Texas). I have, like all of us, been on and off diets forever. In 2008, I was diagnosed with PCOS. In 2009, I was diagnosed with diabetes and my dr. and I briefly discussed lap-band--actually, he discussed it and I ignored it. We talked about low-carb diet stuff. Then I got pregnant, then I was breastfeeding, and so on.

But once I had my baby, I knew I needed to do something to make sure I lived to see her grow up. So in January, I went back to my doctor and he told me I'd need to do a six-month diet. I started, but I'm not very patient, so in April I went ahead and made an appointment to meet with a surgeon. In May, I did the required psych eval and met with my surgeon's office's nutritionist. At this point I had been through four of the six months of the diet.

My surgeon's office decided to go ahead and try submitting the paperwork, anyway--they sent it in last week and it was approved today. Apparently they were willing to discount the pregnancy/breastfeeding months and counted those discussions in 2009 as part of the six-month diet plan.

[vickyd 24]

I have UHC and I didn't have to do the 6 month duet but I did have to provide 5 years of documented weights showing I had been obese.

[lizzy2150 3]

Oh! And I have a friend who was banded nine or ten years ago (she went to Mexico). She just had her second band-baby last week and is doing well, so there ARE people who do well with the band as a long-term implant (so far, anyway).

[Wheetsin 714]

Just my observations/research/opinions...

The band as a long term solution - sometimes. Beyond the 4 year mark, I know, and have seen, and have read about, and have been told about a LOT more people who have it removed than who still have it. I personally do not have faith in it as a long term properly functioning device. I think people who keep their bands for more than a few years, and are truly complication free (not to be confused with have unknown/undiagnosed complications), are the exception rather than the rule.

If your plan requires a supervised diet, you probably can't get around it. Having a history of going to the doctor and being weighed for your visit doesn't count, they want it to be doctor's visits specifically for the purpose of supervised diet. I had my band under UHC and they did not require the supervised diet, nor did I have comorbidities, and I was approved in about 3 days. But that's all so specific to your particular plan, take it with a major grain of salt.

I've recently submitted my paperwork for revision surgery and my current provider (no longer UHC) requires a 6 month diet for all bariatrics. We're trying to see if the fact that I've had a lapband for going on 5 1/2 years, and have technically been under the surgeon's care during that time, will count. They are also trying to see if there's a waiver for revisions, or if it's truly required for all bariatrics. The office staff are more optimistic about that than I am, but we'll see.

[54Shirley 105]

I'm going on 5 years this October.