How difficult is it to get insurance to cover revision from lapband to bypass due to mechanical failure?

[T.Daelynn 1]

I had my lapband surgery in July 2011. It slipped in July 2012 but it fell back in place once the Fluid was removed. I had it refilled the last week in December and it slipped again last week. I only had it filled for about 2 1/2 months before it slipped again

My doctor wants to remove it and would like to do a revision to bypass or the sleeve (my choice).

My question is, how hard is it to get approved for a revision due to mechanical failure? I'm worried because my bmi is 36 with no co-morbities. I'm the same weight as I was before the surgery.

I have priority partners in Maryland. I was self-pay for my lapband.

Thank you!

[Marla 35]

I had my lapband surgery in July 2011. It slipped in July 2012 but it fell back in place once the Fluid was removed. I had it refilled the last week in December and it slipped again last week. I only had it filled for about 2 1/2 months before it slipped again

My doctor wants to remove it and would like to do a revision to bypass or the sleeve (my choice).

My question is' date=' how hard is it to get approved for a revision due to mechanical failure? I'm worried because my bmi is 36 with no co-morbities. I'm the same weight as I was before the surgery.

I have priority partners in Maryland. I was self-pay for my lapband.

Thank you![/quote']

I had no problems getting ins to cover mine with Aetna ins......

[SoccerMomma73 1,867]

I had my lapband surgery in July 2011. It slipped in July 2012 but it fell back in place once the Fluid was removed. I had it refilled the last week in December and it slipped again last week. I only had it filled for about 2 1/2 months before it slipped again

My doctor wants to remove it and would like to do a revision to bypass or the sleeve (my choice).

My question is' date=' how hard is it to get approved for a revision due to mechanical failure? I'm worried because my bmi is 36 with no co-morbities. I'm the same weight as I was before the surgery.

I have priority partners in Maryland. I was self-pay for my lapband.

Thank you![/quote']

The ONLY reason I got approved was because of mechanical failure....my insurance co has a strict 1 bariatric surgery policy but because I had lost significant weight with my band and followed up with my doc semi-regularly and THEN my band slipped, they made an exception to their policy Because of this. Also, at the time of my removal, my BMI WAS 36 with NO comorbidities...my hypertension had resolved with weight loss and I was on no meds but Vitamins....insurance was smart enough to look at my pre-band data and base approval on that assuming (correctly) that without the band my weight would go up and my hypertension would return...

I was PETRIFIED I wasn't going to be approved but they really used their brains and I was impressed!!!

Good luck!!! I wish you the best!!!

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 226.6

[T.Daelynn 1]

Thanks for the responses! I'm worried that they will remove the band and not approve the new surgery

[SoccerMomma73 1,867]

Thanks for the responses! I'm worried that they will remove the band and not approve the new surgery

Good luck!!! Keep us updated!!!!

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 226.6

[T.Daelynn 1]

Denied:( they approved the removal of my band but not a revision due to my bmi being 37 with no comorbidities. They said I have to start all over again.... Supervised diet for 6 months etc.... (Which I won't get approved anyway cause bmi is under 40)

I was self pay for the bank 1 1/2 years ago.... I'm devastated.

[T.Daelynn 1]

I also didn't have a food diary for 6 months:( I was thinking about creating one for the past 6 months, maybe that will help with my appeal. Ugh wish I kept one

[SoccerMomma73 1,867]

Sadly I gained 30 pounds during my 6 month wait, my BMI went from 36 to 40....you would THINK they'd realize that without your band your weight and co-morbidities are likely to go up. I'm so sorry. I wish you the best. Absolutely appeal that decision!!!!

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 225.8