Eroded Lap Band To Gastric Sleeve - Six Month Weight Plan Required?

[FXDF2008 14]

I'll try to make this short and sweet

I had lap band surgery in February of 2007. I was diagnosed as eroded in November of 2011 and was removed in March of 2012. I elected to switch to a new surgeon to perform the gastric sleeve surgery who required that I wait six months after the removal of my band in order for the scar tissue to heal and the adhesions to settle down. He also required that I have an upper GI, an upper endoscopy and an esophogeal monometry in order to ensure that I would be a good candidate for a high pressure system like the sleeve. I passed all tests with flying colors.

I have BCBS-AL. They covered the removal of the band and the subsequent tests mentioned above; however, they have denied my pre-detemination for sleeve surgery until I complete a six month weight loss management program. They stated that since I do not currently have a bariatric procedure that I am essentially having to requalify all over again.

Is it me or does this make absolutely no sense at all! Their policy plainly states that they cover repeat surgery as a result of band erosion with no exceptions to that policy listed. We are appealing based on the fact that my surgeon determined that it was medically necessary to perform the revision in two steps and that it would have ben unsafe for me to do otherwise.

Has anyone had a similar experience? I feel like I am the only one who has ever had an eroded band and had to wait six months to complete the process.

Help!