Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Denied for Conversion - Slipped Band



Recommended Posts

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

Mexico and self pay is an option.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LadyVeteran1

      Sleeve surgery is on April 14th.  I am counting the days!!  Can't wait!
      · 1 reply
      1. Brookie2shoes

        Me too girl!! Are you in the full liquid diet right now? It’s sooooo hard!

    • buildabetteranna

      Down 33 lbs and slightly stalled, but I'm gonna reevaluate and push through. I started back to work last week after 2 years of being disabled due to mental health as well as my weight. It's a great job and I'm just so happy to have this opportunity at a second chance at life. Hope everyone is having their best journey ❤️ Together, we got this!
      · 2 replies
      1. DaisyChainOz

        Great work Anna! Keep it up 😁

      2. buildabetteranna

        Thank you ❤️

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 1 reply
      1. stevieoriole

        Am feeling this right now. My surgery date is 4/1. Sign the consent tomorrow. I feel like I overloaded myself with too much info, too many opinions. Got to the point where I was wondering if I should do this. Then I thought of my reasons for taking this step and that settled my nerves. Still get moments of doubt but am striving forward. Am just going to follow my book from the surgeon. Joined this because I was told by my dietician that I should do this for support

    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×