Once-in-a-lifetime benefit?

[BeautyLocs40 16]

In 2009, I had a lap band inserted, a procedure that was covered by my insurance carrier, Blue Care Network. Five years later, I've lost and maintained a loss of 40 pounds. Still significantly overweight, in December, I started steps to get my band revised to a sleeve. Prior to beginning in earnest, I contacted my insurance company (BCN) and was told that a revision wouldn't be covered because WLS was a once-in-a-lifetime benefit. I called back and spoke to someone else at the insurance company and was told that wasn't the case. So long as the procedure was deemed medically necessary by my surgeon, the insurance company would consider covering it. I called a third time; spoke to another person who told me the same thing. Finally, I contacted the benefits management company retained by my employer and asked them to get a definitive answer. Once again, I'm told it's not a one-time benefit. About a month ago, BCN agreed to cover both the removal of my band and revision to a sleeve. Last week, however, I received a benefits update from BCN. Effective September 1, WLS is now a once-in-a-lifetime benefit.

I've been approved and have no real worries about the decision being overturned, but I am concerned about the trend of insurance companies placing this limitation on WLS. If a patient needed multiple procedures to manage other chronic conditions, would they encounter similar barriers? I fully understand that the band, sleeve, and bypass are tools, and it's up to us to make the life-style changes necessary to be successful, but as we've learned, some tools aren't as effective as others for many people.

I'm very interested to hear your thoughts. From my perspective, the once-in-a-lifetime stipulation seems to be punitive toward those of us with weight challenges. Perhaps I'm reading too much into this, but to me it's like saying, "You were given the ultimate opportunity to shed your fat ass, and you failed - AGAIN - so no more chances for you!"

What do you think? Am I over-reacting or is this further confirmation of general acceptance to discriminate against fat people?

[2muchfun 8,927]

It's easy for me to understand the insurance carrier's position. If you failed with one WLS, why would you succeed with another? People fail with all WLS techniques mostly due to patient compliance issues. The band does have a higher % of complications of course and if the procedure is causing some life threatening issues, I can see why they should offer a revision.

But to revise because it just didn't work out, could be a problem for some carriers. Trial and error is very costly and health care is already very expensive. jmo