Dr. C or anyone who can help???

DJV22 · July 3, 2006

Hi everyone. I am new here, referred by someone. I would really appreciate any help you can offer.

I have been banded for 4 years and have struggled for 3 of those 4 years. I haven't had any official complications until recently, but the band has only served as a tool to keep me from gaining, it hasn't helped me lose in quite some time. I belong to other support groups, so I do know what I takes to make this work for me and believe me, I have given it my all.

I was banded in Mexico by Dr. Sanchez and have had follow up care in the states with a couple of surgeons. But I have been unfilled for over a year because when filled I experienced major discomfort and a dry cough the doctors believed was due to undetected reflux. So I wanted to be safe, not sorry and had my band emptied. Well since then my restriction has seemed to slowly come back - implying a possible slip. I went in January for an endoscopy to make sure there was no erosion (since I hadn't had one since banding) and it showed some gastritis and inflammation (had my esophoagus dilated) and a return of the hiatal hernia I had repaired at the time of banding.

I then went a couple of weeks ago to get an esophogram and it appears my band has slipped (and it's been empty for a year). Since I was self pay (due to insurance exclusions) I am now facing a self pay for the removal.

Problem is I am BROKE. I have spent a lot of money trying to make this band work for me and now that I may have to have it removed I just don't know what to do.

Does anyone have any suggestions on how I can get my band removed and have my insurance pay for it because of issues NOT related to the band? Like to go in and fix my hiatal hernia and just take the band out while in there? I assume a band doctor is the only doctor who can do this??

I can hardly eat, I throw up after almost every meal and if I can get food down it causes pain. I obviously can't live like this, but without money what is a person to do? I don't own a thing.

Thanks for any help you can offer.

-JP

Trace Curry · July 3, 2006

There is a CPT code for band removal - it's 43772. Call your insurance and see if it's a covered code. It's done rarely enough that it might slip through. You might be able to talk your surgeon into fixing the hiatal hernia and taking out the band and just billing for a hiatal hernia. The only thing I would definitely suggest is that only a band surgeon should do this operation.

Good luck,

Dr. C

Cincinnati, Ohio

www.TheBandDoctor.com 877.442.BAND

DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

Hi everyone. I am new here, referred by someone. I would really appreciate any help you can offer.
I have been banded for 4 years and have struggled for 3 of those 4 years. I haven't had any official complications until recently, but the band has only served as a tool to keep me from gaining, it hasn't helped me lose in quite some time. I belong to other support groups, so I do know what I takes to make this work for me and believe me, I have given it my all.

I was banded in Mexico by Dr. Sanchez and have had follow up care in the states with a couple of surgeons. But I have been unfilled for over a year because when filled I experienced major discomfort and a dry cough the doctors believed was due to undetected reflux. So I wanted to be safe, not sorry and had my band emptied. Well since then my restriction has seemed to slowly come back - implying a possible slip. I went in January for an endoscopy to make sure there was no erosion (since I hadn't had one since banding) and it showed some gastritis and inflammation (had my esophoagus dilated) and a return of the hiatal hernia I had repaired at the time of banding.

I then went a couple of weeks ago to get an esophogram and it appears my band has slipped (and it's been empty for a year). Since I was self pay (due to insurance exclusions) I am now facing a self pay for the removal.

Problem is I am BROKE. I have spent a lot of money trying to make this band work for me and now that I may have to have it removed I just don't know what to do.

Does anyone have any suggestions on how I can get my band removed and have my insurance pay for it because of issues NOT related to the band? Like to go in and fix my hiatal hernia and just take the band out while in there? I assume a band doctor is the only doctor who can do this??

I can hardly eat, I throw up after almost every meal and if I can get food down it causes pain. I obviously can't live like this, but without money what is a person to do? I don't own a thing.

Thanks for any help you can offer.

-JP

DJV22 · July 3, 2006

Thank you Doctor.

Would you happen to know if calling my insurance company would raise red flags, as they do not know about my band? Then if I were to get a doctor to do the surgery as only a hiatal hernia repair they would not cover because I called inquiring about band removal? I am not even sure I am asking this right..... but I am 99% sure my exclusion will prevent this from being covered and I don't want to risk any chance of getting it covered another way.

And as a Bariatric Surgeon, is there an appropriate way to ask about doing this so my insurance would pay?

Thanks so much for your help!

Trace Curry · July 3, 2006

I guess it's possible, although in my experience insurance companies are so disorganized half the time when you have a written approval for a procedure in your hands they still have no record of it. Tough call I guess. There isn't any special way you can sweet talk them, either it is or it isn't.

Dr. C

Cincinnati, Ohio

www.TheBandDoctor.com 877.442.BAND

DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

karenj · July 4, 2006

Dr. C,

I justed wanted to thank you for helping this person. In a time of need, it is nice to know that someone will talk to you!

KJ

DJV22 · July 4, 2006

yes yes, thank you for your help. It's nice that some doctors care enough to at least lend an ear and offer some advice.

Constance · July 5, 2006

Have you had any contact with Dr. Sanchez? Could they help you or give you a discount or something?

DJV22 · July 5, 2006

I have been in touch and they said it's $4500-$5000 for band removal. I tried to find out if it could be cheaper, but so far no luck.

Constance · July 5, 2006

Oh I'm so sorry. Can you plead with them on the money issue? Or could they let you do a payment plan? You are really suffering and if it could be their fault, they should take care of you!