Question for BCBS FEP Band-Sleeve Folks Since 2011

[SleevedSteph 4]

I also posted this in the Band to Sleeve Forum. I was banded in 2005 and did great - lost 140 pounds in 2 years and maintained until leak in 2009 and also found out I was pregnant - so no restriction and pregnancy was not a good combo and couldn't get band repaired until after baby. Gained half the weight back and then in 2011 got the band repaired (ended up just the port had to be replaced) and lost the weight back. Last October, noticed I did not have any restriction and fluro xray confirmed a leak again (where unknown). I have now gained over 40 pounds since then! I am a federal employee and had GEHA since 2005 (BCBS would not cover band at that time). Both my husband and I got the band in 2005. Early in 2012, my husband had to have his fill removed due to dilation of the esophagus (which I had never heard of before) and he started gaining weight rapidly and after consulting with the surgeon decided to convert to sleeve. I was against that but then went online and saw that it was not uncommon. Well, we were with GEHA and he was able to get band removal/conversion to sleeve approved with no problem and had it done in December and is almost back down to his lowest band weight. He loves the sleeve as the last couple of years he had so much issues with the band. Well at the same time I found out I had another leak - I also learned that my 2 yr old required intensive speech therapy which GEHA had very limited number of visits but BCBS FEP had better coverage for speech therapy so I switched to BCBS for 2013. I wasn't too concerned with me as I was hoping that I would maintain/lose weight without WLS (that didn't work!) and had always heard how great BCBS FEP was as far as approving WLS. Well, I found out that their requirements changed in 2011 and it applies to second WLS as well. I thought since my band was defective that insurance would want me to have conversion (since this is my 2nd leak and the long term results of the band has not been what the medical community thought) or at a minimum replace the band to avoid me getting to the weight I was before WLS and the health risks that come along with that. Well, I received a letter stating that band removal was approved but all the requirements must be met (for initial WLS and the additional requirements for subsequent WLS?) before conversion would be approved. There were no specifics in the letter as to what specific requirements had to be met. I tried to talk to someone at BCBS - but unlike GEHA where I could talk to the bariatric specialist - I can only talk to the customer service rep and all communication as to go through my surgeon's office. So I have asked them to find out from BCBS if EVERY requirement has to be met (morbidly obese for 2 years!, etc.) before conversion will be covered. If that is the case - will they at least replace the band now? So for those of you with BCBS FEP who have converted since 2011 - any suggestions you could give me would be greatly appreciated! I found a great appeal letter from "Britt" but it was before the requirements had changed for subsequent WLS. Thanks!!!

[chinamama 104]

Just had my band converted on the 29th FEPblue basic had to jump thru the hoops 3 month dr supervised weight, 3 nut visits, pcp recommendation, sleep dr, initial denial since they were missing documentation. Dr did a peer to peer and submitted missing documents and I was approved.