Any Insurance Problem With Going Fron Band To Sleeve?

[Krismarie0605 6]

Hi everyone ! I got my lap band in may 2006 not so lucky with that ! I have really been reading about the sleeve and i have my appointment set for friday aug 10th to talk to my doctor . I guess my one thing is did anyone insurnance give them problems because of failure with the band ? I have united health care epo(the new ppo) . I work for the state of maryland and got the best packet they had. Just hope you guys and girls can tell me any insurance stories so I have a idea of what look foward too! Thank you all and best of luck in everyones weight loss journy !

[PEvette 297]

Well some insurance companies only cover one WLS procedure for life...I would call the insurance company directly to see what the requirements are....

Alot of people like to rely on the doctor's office to do the work for them, and when something is missed and their stuff is denied, they like to blame the doctor's office when if they called the insurance company themself it would've saved time...

I called and was told revision would not be covered on my policy so I self paid

[Shayyt 26]

Depending on thier requirements, it may be like qualifying all over again. I didn't think I was going to be approved cause my BMI wasn't real high as it was when I got the band initially but surprisingly I was approved. I was also worried cause I now have Aetna versus BCBS when I got the band and I haven't had the best of luck with Aetna. My doctors office had me do the nutrition classes and the doctors office had to show Aetna that in addition to the complications I was having with the band that when I was originally approved for the band I had at least two co morbidities (Aetna requirements apparently). Every insurance company is different and some companies have limitations on what they will cover. My last company had WLS as an exclusion so it wasn't till I changed companies could I even persue WLS. I would say to speak with the insurance specialist at the doctor you are going to and they will more than likely be able to tell you what will be required and if not they can definately find out. I know my doctors insurance specialist had a liason with Aetna she was able to reach out to. Good luck to you!!

[Krismarie0605 6]

Thank you everyone for everything fine out more come not week fingers crossed

[want2bthin 93]

I also have United healthcare PPO and I was denied and lost two appeals with them. I submitted a third appeal to my employer. Since my employer self funds the insurance they eventually overturned United's decision. United did approve me right away for the lap band removal but they denied the sleeve surgery. Their main beef was that they wanted me to do a six-month preop diet again and I thought that was ridiculous since I had already done that to get the lap band, I had the band for six years so to me I had been on a diet effectively for the last six years.

Thing is that just be safe I started the six-month preop diet and it was exactly at the six-month mark that the appeal was finally overturned.

So if you already completed or are on the way to completing a six-month preop you'll probably be fine. If you run into problems and want more information on what I did to win, contact me by the message feature in VST

I hope for your sake that you get approved quickly and don't have to go through what I went through. It was emotionally and mentally exhausting.

[Krismarie0605 6]

Thank you and are very sorry for the troubles u are having . I work with the state of maryland so I dont think the employer will be the problem . I didn't use them to have my lap band put on . I have been going to a diet doctor for 2 years now never lost over 10 lbs and I also have my proof of my gym memember ship so I am hoping that will help and my bmi is 44 so I hope it works in my favor

[want2bthin 93]

Just make sure that you have proof of monthly weigh ins with the diet doctor and that he's not the same doctor has your gastric surgeon. Sounds like you have everything you need and I'm sure you should be approved quickly.

[Krismarie0605 6]

Thank you everybody for the advise ! I do have my paperwork and weight in's from, proof from my gym proving memembership (never hurt to try) a letter from my denist saying that the therwing up is doing damange to my teeth and also where my primany care doctor put me on a supervisored diet with 3 weight in docoumented .

[Krismarie0605 6]

From my diet doctor (sorry)