Question about insurance and revision

[spoiltmom 44]

I'm trying to get a revision. I got my band 3 years ago. I've lost all but 15 pounds so I'm barely overweight now. Do you think insurance will gripe about that??

My insurance has the easiest bariatric process ever so I'm hoping not. They do not require a six month diet or medical records: only a letter from the surgeon stating your current diagnoses and health problems. It only took them 4 days to approve my initial band.

[JoiaRox 430]

Can I ask why you're putting yourself through such a serious surgery for 15 pounds? Has your band slipped?

[spoiltmom 44]

Because I've lost and kept off 70 pounds that I've never been able to keep off on my own. The band has caused some sort of irritation to my esophagus and my food stays in my esophagus too long instead of traveling down to my pouch. I'm also throwing up constantly or on liquids to prevent throwing up:(

[JoiaRox 430]

Sounds like your band may have slipped - intolerance of solid foods is a good first step! Your insurance may cover the revision at your low weight if you've got slippage - that could lead to fatal consequences (trust me - been there, done that...for 2+ years).

[spoiltmom 44]

Believe me it's still a super hard decision for me. Im scared of gaining my weight back and that's why I want the revision. At the same time I start to feel like a failure all over again because I can't get a handle on my weight without help:(

Even at this low weight I still have sleep apnea that has actually gotten worse since I was banded.

[Nursebarbie 392]

That band failed you. It is not a good device and I am sure it will be recalled with the failure and complications rate which exceeds FDA standards.

[Kat_C_2013 3]

I prepared myself for a battle with my insurance (United Health Care West), but my surgeon told them the facts: the band had prolapsed and I was having many issues, including vomiting in the middle of the night while sleeping because literally food and liquids could not move through from 4-5 hours prior! He put in the paperwork 12/6/12 and I had surgery 2/12/13 - I have never had that quick of a turnaround with insurance EVER. If you are having even one major issue (which I would say irritation to your esophagus is a major one) then you should definitely pursue the revision with your surgeon and your insurance. If my insurance would have approved the sleeve initially I would have done it, but they didn't and I knew I didn't want my anatomy re-routed with the bypass. You are very smart to want to deal with this before it gets worse physically and you gain the weight back. Lastly, as far as feeling like a failure - I try to think of it this way - weight loss surgery gives us an even playing field. If you were disabled in a wheelchair, would you think having to use a ramp instead of stairs made you a failure? No, you would see the ramp gives you equal access to stores, offices, etc. It is seriously the same for us, we need equal access to a life without obesity and all of its comorbidities! That doesn't mean we get a free pass, we still have to plan meals, exercise, etc. so we are not failures, we are people functioning on an even playing field so we can be successful & healthy!

[spoiltmom 44]

Kat, how close to your goal weight were you when you tried for the revision??

My weight is what scares me right now. I'm afraid they may turn me down because I weigh like 165 now but surely they will take into account that I started out at 235 right?

[Kat_C_2013 3]

I had actually gained a lot of weight because I was on a depressed, self-imposed Jack n the Box milkshake diet!! But my mom prolapsed her band and was at goal weight for like 6 months and had only gained 5 (literally) pounds and her revision was approved because the surgeon could not repair the prolapse. So I am not your insurance company, but I would think the issue with your esophagus overrides the actual number of your current weight. Worse case scenario is they deny the revision and you appeal. But, stay positive!

[spoiltmom 44]

Thanks Kat!

[pamelawilliams16 4]

Kat' date=' how close to your goal weight were you when you tried for the revision??

My weight is what scares me right now. I'm afraid they may turn me down because I weigh like 165 now but surely they will take into account that I started out at 235 right?[/quote']

Congrats on your weight lost but 165lb is a very low weight. The sleeve will make you loss pounds real fast and a lot. I would hate to have you loss to much because you started off low. Good luck on what ever you decide.

[Fixerupper 335]

There is at least one person on these boards who had a revision solely for the purpose of maintenance. She had lost all of her weight with the band but then her band went bad. I can't remember who it is but hopefully she'll see this and chime in. I am a revision too but unfortunately was not nearly as close to my goal weight as you are because I was existing on slider food couldn't keep any real food down. My band was also irritating my esophagus and my stomach. The problems were starting to get serious. insurance covered my revision with no problem.