Did You Insurance Pay For Band To Sleeve Revision?

[Gigi_Girl 77]

I am attempting to get my insurance carrier to pay band to sleeve revision due to a leak in my band system. If you had a defective or failed band, what portion of the revision did your insurance cover?

By the way, my BMI is 35.

Gigi

[iwannabslim 67]

My insurance pays for revision surgery, but I am still waiting on word from them... It seems like they are willing (if I meet their unknown requirements) to pay 100% after deductible. Sadly for me, the requirements are apparently obscure, unlike the original requirements of 5 year history, 40 BMI (or 30 BMI with comorbidity), and 6 month supervised diet...

[Gigi_Girl 77]

Thanks iwannabslim, I'll keep my fingers crossed for you too. Funny how they they keep things to themselves. My insurance says they will pay for revision if either band erosion or slippage OR infection around the port site. It doesn't say anything about leakage, but one would think, a defect should be covered. I'll keep you posted.

[AmberK1026 9]

I have a slipped band and I just got approval from my insurance company on Monday (Aetna) for removal of the band and revision to the sleeve!!! Surgery date is scheduled for May 29th!

[I WONT MISS ME 1]

Yes, I have United Health Care. I had scare tissue and had not lost any weight in over a year. They paid for everything but the $1k deductable.

I had to jump through hoops, 6 monthly visits with a nutritionist and a psych evaluation. But, it was all worth it in the end!

[Colorchic 13]

I had revision 3/30 and have BCBS state of Florida and they covered!

[Gigi_Girl 77]

Colorchic, good to know. Let's home BCBS of AL will do the same. How long did it take for them to approve?

As a side note, I have been reading reseach on the band and discovered that they have a 40% fail rate and if rebanded instead of revised, the fail rate for the second go round is over 50%. Hope the insurance companies realized revising it once is cheaper and healthier than replacing it twice.

Gigi

[Colorchic 13]

I hope they approve it for you! I had a band slip and was necessary so I had approval right away. My BCBS had originally paid for band.

[ChaChaBurch 60]

I had the band in 2007 - paid for by my insurance (BCBS). At the time we lived in Dallas, and DH and I both had the same insurance (BCBS of Minnesota - our employers home office was in Minnesota). We moved to Arkansas in 2009, and I had problem after problem with my band (I didn't work, and DH insurance didn't cover anything to do with WLS), and I couldn't find a single Doctor in AR that would have anything to do with my band - since they weren't the one who put it in. In September 2012 I started researching the sleeve. I found a great surgeon in Hot Springs who used to do the band but quit because he felt it wasn't effective, and had a large failure rate (DUH). He began doing the sleeve and was very pleased with the overall results. He agreed to do my revision (although he had never done one before - but being a general surgeon, I felt VERY comfortable with him). I began the process in January 2012 (figuring I would self-pay ($16,000 out of my 401k). His patient advocate called me about 8 weeks prior to surgery saying that she had heard that BCBS Anthem was paying for the sleeve beginning in 2012. She submitted all of my paperwork to them . . . . and SURPRISE!!! They approved it - first letter. I couldn't believe it. I had my revision surgery 3/22/12. I just received today the EOB and sure enough, they paid all but $2500. I was so afraid that they would change their mind at the last minute, or figure that somehow I didn't fit their "idea" of what they should approve. It was such a load off my shoulders.

[1maryreigel 31]

I had my lapband in 2008. My band has a leak. They sent the paperwork to my insurance ( Optima ) and they gave their approval within 2 weeks for me to have the band to sleeve revision. They pay for all of it.

My surgery is May 3

[Gigi_Girl 77]

1maryreigel, I will be thinking of you next week. I am encouraged by your response. It has been one week since doc filed with insurance. Keep your fingers crossed.

Keep us posted.

Gigi

[jerseyjandj 105]

I had my band in 08, lost 120 .sooooo happy then I became pregnant with twins after the told us we couldn't become pregnant on our own.had a great pregnancy gained 40pounds. Delivered 7 pound babies.then it slipped and I had it lossened more in more even with nothing in my band I threw up.uk had my recession on April 24, after 5months of jumping threw hoops and I started at 290 surgery day now I'm 258

[Wheetsin 714]

I am attempting to get my insurance carrier to pay band to sleeve revision due to a leak in my band system. If you had a defective or failed band, what portion of the revision did your insurance cover?

By the way, my BMI is 35.

Gigi

My insurance paid for my revision, minus my copays. I do not have deductibles or coinsurance with my plan. My inpatient copay was $250. That has covered all surgeon's office visits. Psychologist visits each have a copay of $20 ($40 total so far). The nutrition/information class also had a copay of $35 IIRC.

Most of the time (I've seen one exception) BMI requirements are waived if you are a revision. Pre-op diets usually are as well. If a Center of Excellence, I believe psychologist rec is still required (was for mine).

My band issue was a "profound" slip. I was not considered a candidate for repositioning or rebanding, which was fine with me. Here's what my insurance ordeal looked like:

Banded with UHC in 2006.

Changed from UHC to Cigna in 2009.

Slip diagnosed in June 2011 while under Cigna.

Cigna covered band removal September 2011 and requisute pre-removal testing.

Cigna denied sleeve (though covered) November 2011.

I appealed denial December 2011.

Cigna overturned denial & approved sleeve December 2011. (By then I knew our provider was changing again 1/1/12 so with that deadine there wasn't time to schedule surgery).

Changed from Cigna to BCBS January 2012.

Submitted my "appeal package" paperwork to BCBS January 2012.

Before BCBS would approve/deny, I had to complete the nutrition class and get psychologist approval.

Nutrition/psychologist both completed January 2012.

Paperwork re-submitted to BCBS early February.

Pre-approval received about 3 days later.

I THOUGHT Cigna would approve on the first submission, and I would have my sleeve in November 2011. I also thought my surgeon's office would submit for the removal and revision at the same time. Having so many months between the two is really what caused so much delay. But then again, he requires at least 2 mos between procedures, and most pre-approvals are only good for 60 days. But regardless - they had a disappointing delay on their end that really did stretch it out.

Your SPD will detail whether or not revisions are required, revisions from what to what, and what the criteria are. I like to look all this up for myself, but your surgeon's coordinators can also tell you (they usually have it faxed from your provider).

[Julianne16 2]

I have Aetna. They have approved both the band removal and the sleeve (after meeting my deductible) even though I had no band complications -- just wasn't losing weight. I also didn't have to do the 6 month diet, just the psych eval.

[Gigi_Girl 77]

_{Wheetsin, thanks for your history. My provider is BCBS of AL. They say revision are possible for infection of port or erosion or slippage of band. Nothing is said about leaks. I was told it is a case by case basis. I checked again today and still no answer. I'll wait another week before I call back. Thanks again for your support.}

_Gigi