What do I do now???? Help Please!!!!

[STARLIGHT 0]

ok here is my story......I had lap-band surgery in July 2008 and I lost about 75 pounds, granted I was throwing up most of my food that I ate, so I am sure that’s why I lost the weight. In my mind throwing up and losing weight and having a little bit of port pain and side pain was outweighing not having to take blood pressure meds and having sleep apnea and getting heart disease, (which runs in my family) so I just dealt with it up until March of 2011 when I got to the point where I could not get any food or Water down without it coming right back up and I starting having really bad reflux and pain in my stomach and port area. I had to go to the Dr. and he removed all my Fluid to see if it would resolve the problem and let my band reposition itself and give my stomach time to heal from all the vomiting and inflammation. Over the next several weeks I was able to eat and not vomit every time I ate, but I would still get nauseated and the pain would still be there, not bad like it was before the unfill but still there. Not to mention I started GAINING MY WEIGHT BACK. In May 2011 I went back and the Dr. started to try to refill my band starting out with a small amount of fluid, at first it seemed to be ok but after a week or so the pain and vomiting came back full force which just happened to be on a weekend and I tried calling my local emergency rooms and get them to take out the fluid and they said that they would not touch me I would have to go and see my Dr. So the first thing that Monday morning I called the Dr.‘s office and they told me to come in and they would remove the fluid. Once again it was like relief. Of course I am still having stomach pain and port pain after eating and nausea, vomiting and reflux. I have talked it over with my Dr. and he decided that my band was malfunctioning and causing all the pain and problems that I am having and that he could go in and reposition it but the likely of it happing again was great, or I could revise to the sleeve or the bypass but it would be my choice so I decided after weighing all the options that my life and health would be better off with the sleeve. So I gave the ok for the Dr.’s office to proceed with the paper work for a revision due to the band malfunctioning and all the complications that I was having. I cannot live with this kind of PAIN and VOMITING ,not being able to eat, health ,and gaining all my weight back that I have lost, and all the co-morbid health related issues reoccurring again. I had read my INS policy and it states that it will approve and cover a revision for compilations related to the first surgery which was the lap-band. I received a denial letter from United Health Care’s Coordination department stating that I did not meet the BMI to have the surgery and that this did not have anything to do with my band.

Have they lost their mind or what??? what do I need to do now.....any help would be great.

[KristeyK 3]

Appeal the decision. Make sure your surgeon sent in something written that states he believes you need the revision because of the band failure. I would also have your primary care Dr. write a letter and give that to your surgeon's office to submit with the appeal. YOU should also write a letter stating everything you've been through because of this. ANYTHING you have that documents your issues since having the band will only help your case.

Hopefully someone else will be able to chime in with more advice. GOOD LUCK! I know how much that band sucks when it malfunctions. It's not an easy thing to have to live with.

[lulugirl 20]

I dont understand insurance companies.. I had a lap band placed 7/2007 with Dr Aceves. I started out at 215 & got down to 157... It then became really difficult to eat, things got stuck. i could eat ice cream but not chicken, salad, beef..etc..

I decided to have it removed 7/2010 & my insurance covered it, i weighed 168 when I had it removed. Now 1 year later i weigh 198 lbs. My insurance is denying VSG & gastric bypass because my BMI is 37 & I have no comorbidities. i am panning to go back to Mexico in fall for VSg as a self pay..

very frustrating........

i

[Wheetsin 714]

Did you see the questions I posted to you on this same topic in the revisions forum?