Blue Cross Blue Shield Federal - Basic and Standard (Texas)

[band2RNY 12]

I got the lap band in 2009 and it just has not worked for me....

I finally went back to my doc in Austin after a year of not going. I asked him about getting the revision from lap band to sleeve or another procedure as a revision.

He told me that I have to see him for at least 6 months consecutive with no weight loss success or have complications in order for my insurance to cover it.

Does anyone know any loop holes? Or, is this the same as what has been said to you?

Any help would be greatly appreciated.

I have basic right now but if I need to switch to standard to make it easier to get the procedure done..I will do that..just FYI

[happy55 2]

I was told the same thing/ and or gain at least 250 lbs. I said that ain't gonna happen if I could help it.

I also have Fed, BC/BS standard. I have not really been satisfied with the band. Either to tight or not not tight enough. Have never been at the so called "sweet spot". Have been banded since 2008.

[band2RNY 12]

I had some xrays done so maybe they can find something with those xrays that will be a complication. The doctor that did the xray said he saw a little bit of slippage. No erosion... i wake up with pains in my shoulder blades.

I'm hoping to get the sleeve.... or RNY.

Thanks for your help.

I have found in the past that some bariatric doctors are not familiar with our insurance and require us to do stuff that in the past our insurance didn't require...... like diet for 6 months... a psych eval.... it seems as if they make everyone do that even tho the insurance didn't require it at the time. SO, I was thinking maybe this was the same type of situation. It makes sense tho since I have not really been under the care of a doctor in a year.

[band2RNY 12]

Well I find out in two weeks of i'm able to go from band to sleeve. I went to see my doc today to get a fill. He is going to review the cd's from the barium swallow in had last month to see if the slippage is bad enough to warrant a revision surgery to gastric sleeve. He couldn't even do the fill today as he couldn't get the needle in the port. He had a hard time last month also but after awhile he got the needle in and i'm still bruised from it. So, either way i'll have to have surgery whether i'm able to stay with the band (to replace the port) or have the gastric sleeve. I'm hoping SLEEVE!

[HotButterFly 981]

Why do you think the band hasn't worked for you? Is it because if the reason stated above: too tight or too loose, or was it something totally different?

[band2RNY 12]

Mostly my fault I think... I started out in Jan 2010 and lost 20 lbs before surgery and 40 lbs after.... the band was adjusted 3 times and it was really working good. I was really happy about it and things were going great.

I wasn't eating all what I was supposed to but I actually hit a spot to where I was barely eating.

I went in for my check-up and they noticed that the band was starting to slip. Who knows really... they took all the Fluid out and I was so freaked out I just didn't want to go back.

So, I didn't go back... left my job...and didn't have insurance that would cover my fills. I gained all the weight back plus 20 lbs. SUCKED SO BAD

So, I took a hiatus until maybe last year..got one fill... had to pay cash and drive 2 hours to a doctor that would take me. He did a scope before he took me in and saw that my pouch was just a tad stretched out and all looked good. Even though the band wasn't tight...I still had restriction.

I finally got insurance in August 2012 and went back to this doctor in July and got another fill that took FOREVER to get the needle in... i didn't lose or gain any weight from the previous fill a year ago. Then, I went in for this 2nd fill a few days ago and he couldn't even get the needle in the port.

I'm still on the fence about getting the sleeve or staying with the band.....he may have to replace the band totally tho. I'm going to talk to him about all that on the 27th. I just want the battle of the weight loss to end and I think the sleeve would just be a better option for me.