Denied for Conversion - Slipped Band

[Bkhuffman292 1]

Cigna OAP has denied me conversion from slipped lap band to sleeve because I haven't seen a bariatric doctor in 3 years. I moved away from my surgeon and just got insurance that has bariatric coverage. From Feb of this year to current I started gaining weight - in excess of 40lbs which lead me to believe something wasn't right. They won't even take out the band unless it is emergent surgery. I'm having problems, not life threatening, just uncomfortable, but I need help either getting a sleeve or revision for this band as my weight is climbing and the problems of reflux, gas, pulling in abdominal area, etc. are not easy to deal with regularly. The PA put me on a 100g Protein, 30g Carb diet and wants me to come back in 3 weeks. They are submitting one more time to see if the insurance MIGHT consider letting them fix this band. Thoughts - tired, frustrated and kinda PISSED off at this point.

[Fixerupper 335]

Hi. I'm sorry you are having such a frustrating experience. We tend to think of reflux problems as merely annoying but they are much more than that. I was throwing up multiple times a day for five years. I did go to my lap band doctor but when he couldn't or wouldn't do anything I just gave up. Finally, after five years of misery I decided to pursue a conversion with a different surgeon through a different program. They had me scoped. Turns out the constant reflux was irritating my stomach and esophageal lining to the point of causing esophagitis and gastritis. They tried completely un-filling my band and putting me on meds to heal the stomach lining and reduce acid. It didn't work. The reflux persisted. Docs told me I could develop a precancerous condition and also lose my gag reflex which could lead to pneumonia infections and even possibly death. They also sent me for barium swallows (I had had at least 4 before) this time they found a hiatal hernia that needed repair as well. Once we had this information my surgeon wrote it up as medically necessary and my insurance approved me almost immediately. I don't say any of this to scare you. Just to make the point that the process can be long and tedious (lots of appointments and tests). But, don't give up. I figured out that my lap band doctor was invested in me keeping that thing in. he just couldn't admit for some reason that it didn't work for me. When I found the right surgeon he wrote it up correctly and presented to insurance correctly. He is experienced with revisions and knew what to say. My band did not slip although the doc suspected it had and then just slipped back into place prior to the x-ray. But, can't a slipped band erode into the stomach. I just can't understand how they are saying it is not medically necessary. Hang in there and keep pushing! My conversion was actually based on "band intolerance" not a mechanical malfunction.

[reshiapooh96 31]

I know how P.O'd you must feel, but hang in there something will come through. I have a failed band now and wanted a sleeve. BC/BS denied converting to sleeve but will pay for RNY. Fortunately for me, I did regularly go to my surgeon who really wasn't interested in having me go in for tests W/O me asking for them. and He seemed P.O'd at me for having to ask. I was gaining weight and miserable too. Somehow, your insurance may pay for converting to RNY due to having issues.

[raven123 97]

Mexico and self pay is an option.