Need advice BCBS TX

[one-day-soon 26]

I will be a revision from the lapband, which was put in by Tricare, my surgeons nurse is concerned that BCBS wont pay to have the band removed. Has anyone been in this situation? Also I just started going by to the surgeon's office to get Fluid out, I had been miserable for a year, throwing up and discussed changing to the sleeve. I had regained the weight I had lost. The office wants to have me make several appointment before the submit my paperwork to the insurance company. I have done my nutrition visit and my psy visit. I was so depressed today because now I don't have a clue when I will get this band out so that I can get a second chance. Has anyone experienced this? Did you get approved. I would love to heard some feedback. The office also said she can submit my paperwork now but if I don't get approved, I only have one appeal. Should I wait and make several appointment or try now, I am so ready to get started. Thanks

[Kami63 215]

I was trying to get approved for 3 years to get he band out. with BCBS My band removal was approved in two days in early May. This was after being denied repeatedly by Cigna for the removal. Cigna basically wanted the band to come out in an emergency situation only. It was so frustrating. I used the BCBS Tx network because I live in tx but my employer is based out of California. I was then approved for the sleeve in two days after the submitted the paperwork in late May. I had my band removed today and revised to a sleeve today all in one!

You can also call the insurance to find out exactly what they will require for removal of the band then the for the VSG. For me thy treated it as two separate cases.

Hang in there and Good Luck

[one-day-soon 26]

Thanks. I will call them tomorrow. I was afraid to call and "rock the boat" before my doc office submitted the paperwork, but I might as well know up front before spending extra money on more visits that I might not need. Again Thanks and good look on your new journey.

[one-day-soon 26]

Thanks. I will call them tomorrow. I was afraid to call and "rock the boat" before doc office submitted the paperwork, but I might as well know up front before spending extra money on more visits that I might not need Again Thanks and good look on your new journey

[one-day-soon 26]

I called my insurance company and the may not cover the removal of my band bc I didn't have that insurance when it was placed and I need to have "significant complication/technical issues" to have it removed. And I have to show compliance with a nutrition and exercise plan.

I had Fluid taken out of my band almost a month ago, I was way too tight, throwing up a lot. Now I'm coughing half way through a meal and have a lot of gas, even on my shoulder. I chew slow and do't drink from a straw.

I made a second appt with the nut and will go to the support group meeting.

I don't know what else to do.

[Kami63 215]

I called my insurance company and the may not cover the removal of my band bc I didn't have that insurance when it was placed and I need to have "significant complication/technical issues" to have it removed. And I have to show compliance with a nutrition and exercise plan.

I had Fluid taken out of my band almost a month ago, I was way too tight, throwing up a lot. Now I'm coughing half way through a meal and have a lot of gas, even on my shoulder. I chew slow and do't drink from a straw.

I made a second appt with the nut and will go to the support group meeting.

I don't know what else to do.

Hey there... Complications can be seen sometimes on an EGD. They can detect hernias from the band, erosion and ulcers. Perhaps that would help them approve the removal if something would show up on the test. Also maybe your pcp or surgeon can have blood work done and see if you have any deficiencies due to the band. I say Pcp because it might be easier to get approved if you have two doctors saying it is medically necessary. Just a few things to think about. Hope this helps. Good luck

[one-day-soon 26]

I had an upper GI today that was negative.i will see my PCP on Tuesday and ask for an EGD. I just know something is wrong with this band.

[one-day-soon 26]

Has anyone had a negative upper GI but something was found on the EGD?