teshadb 203 Posted May 31, 2012 I had lap band in 2008 and I am miserable about how it hasnt done what I thought it should do. I want to go and have the sleeve done. I had a MVP insurance then now I have Humana. What does it take for an insurance company to approve the revision?? Also for a revision to they make you go through all the hoops they did the first time I had WLS or do they just approve the surgery and you dont have to lose a certain amount of weight before hand? Any help with this is appreciated. Share this post Link to post Share on other sites
Calicolea 38 Posted May 31, 2012 Most of the insurance companies have pre-op requirements, if you're just getting a sleeve or a revision, and they all seem to be a bit different. My best advice is to call Humana and ask if they will even cover a revision and what are the pre-approval requirements. I did that with my insurance and they gave me all the requirements for my revision. It was exactly the same as if I had never had my band. I ended up being a self-pay. Best of luck Share this post Link to post Share on other sites
lady lisa 12 Posted May 31, 2012 I can tell you that it normally has to be found medically necessary or a serious problem with the band. Not just the fact that you may not have lost enough weight. Just know that it is very hard to find anyone to accept Humana for weight loss surgery and especially for a revision, if they cover revisions at all. And yes, any good program is also going to make you go through their requirements the same as any new patient, unless you are considering using the same surgeon. Share this post Link to post Share on other sites
CamarilloCA 41 Posted May 31, 2012 I was in the same boat as you not long ago as many others are here. Be sure to check out the lap band to sleeve revision forum and insurance forum as both are helpful. I too had the lap band put in in 2008 (see "My Story" on my Profile Page). I just had revision surgery eight weeks ago to the sleeve. I have Kaiser, and I didn't have to go through classes for the revision, and they covered everything. I had self-paid for the lap band, but I would have qualified through Kaiser back in 2008 if I had wanted to wait for six months while I took the classes. (Classes were once a week for six months in Los Angeles back then.) I was impatient and ended up self paying for the band. I would make an appointment with your Primary Care Provider and ask him/her to refer you to the barriatric program. I think just having the lap band in makes you qualify for having it out at the least and having revision surgery if you want it. I wouldn't think you have to qualify again. At the very minimum, you'll probably have to have an Upper G.I. so that they can see where the band is and what it is doing. You'll also have some blood tests, etc., prior to surgery and possibly an endoscopy. Share this post Link to post Share on other sites
Wheetsin 714 Posted May 31, 2012 It completely depends on what's going on, and the insurance company. For insurance to cover the removal, you will probably need to prove mechanical failure. Some insurance companies may cover some other circumstances, but this is the biggest one. For my removal an EGD was required, as well as xrays, that demonstrated the mechanical failure. For my revision I had to do the nutrition class and see the psychologist. I did not have to do a supervised weightloss (I didn't when I get the band, either, but that was with a different insurance company), which is required for first tie procedures. It's not uncommon for supervised weightloss requirements to be waived when you're a revision - but not always. Share this post Link to post Share on other sites
teshadb 203 Posted June 1, 2012 Most of the insurance companies have pre-op requirements, if you're just getting a sleeve or a revision, and they all seem to be a bit different. My best advice is to call Humana and ask if they will even cover a revision and what are the pre-approval requirements. I did that with my insurance and they gave me all the requirements for my revision. It was exactly the same as if I had never had my band. I ended up being a self-pay. Best of luck if you dont mind me asking how much was it for you to self pay? I have a feeling that the insurance is going to give me a hard time so I need another option to get it done. Did you get a loan???? Tesha Share this post Link to post Share on other sites
teshadb 203 Posted June 1, 2012 What is the cost of the revision in the states???? 1 Calicolea reacted to this Share this post Link to post Share on other sites
Wheetsin 714 Posted June 1, 2012 Self pay, billed, or negotiated rate? Share this post Link to post Share on other sites
MMADAMS0213 2 Posted June 1, 2012 I had a lap band to sleeve in April. When I first had it done 6 months classes this time 3 months. I had to have had lap band 2 yr + and still qualify for surgery. It was approved in 24 hrs but I have BCBS Fed. Share this post Link to post Share on other sites
CamarilloCA 41 Posted June 1, 2012 The cost of revision surgery here in the states can vary, but I would say that the typical cost is around $18,000, which includes surgeon's fee, anesthesia, and a one-night hospital stay, but all that is negotiated really with the doctor that you end up going with. Many people go to Mexico, where there are reputable doctors and decent hospitals and the cost is much lower. Do a search for "cost" at the main forum, and I'm sure you'll find lots of discussions about price. There is even a forum for people who had their surgery in Mexico. Here is my thread on my cost: http://www.verticals...__fromsearch__1 Here is another thread I found: http://www.verticals...__1#entry358683 I'm sure you can find others as well by doing a search for "bill" or "price" or "cost." Share this post Link to post Share on other sites
Calicolea 38 Posted June 1, 2012 What is the cost of the revision in the states???? I've read that a regular sleeve is $10 to 25k and up in the USA. Doing a revision would increase this price. Share this post Link to post Share on other sites
Wheetsin 714 Posted June 1, 2012 My surgeon (US) charges $11,999 for a sleeve. I believe he bills half the surgeon's fee for a revision, which would be $2000, so I'm guesstimating his revision fee would be about $13,999 inclusive. Share this post Link to post Share on other sites
trish151 33 Posted June 2, 2012 I agree that it probably has a lot to do with your insurance. For my band, I had to be on a 3 month medically supervised weight loss program (that was a joke), I had to have a psych eval (which was a joke) and EKG. For my revision, I actually went in for an appointment to get a fill because I was not getting full off of my cup size portion. When I went in they found that my esophogus had dilated. They took 1 cc out of my band and sent me home with not much information. I called the surgeon's office and set up an appointment with him. He sent me for an upper GI and found that my band had slipped. After that, it took them a week to submit the paperwork to the insurance company. It was approved in two days and my surgery date was set for May 30. The day of surgery, they made me take a pregnancy test, drew blood, and did an EKG and took me straight to surgery. I am so thankful I did not have to go through all of the hoops again. I'm 3 days out and am feeling much better. Share this post Link to post Share on other sites
jerseyjandj 105 Posted June 2, 2012 I had band to sleeve 6e wks ago I called my insurance and they said I just needed to find a surf that would do it and they'll pay, wrong! It was like starting all over again 6 months of a nut. crazy doc, and a bunch of other test I didn't have the first time Share this post Link to post Share on other sites
