Aetna Lapband conversion to vsg

[ireallywannabthin 286]

Hi everyone. I was banded on 2/6/13 and am in the beginning phases of converting to the sleeve. I have Aetna and would like to find out if anyone has done this through Aetna and how the process went.

Thanks!

Jennifer

[thesuse2000 698]

Hi - I have Aetna and was converted from band to sleeve this year. In terms of the process, I left that to my surgeon's office to negotiate with insurance, so don't know the details, and for us conversions I think every case is likely different. But I did get approved! And they paid for every last cent of the surgery. I felt so very lucky. I wish you the same success!

[ireallywannabthin 286]

Hi - I have Aetna and was converted from band to sleeve this year. In terms of the process, I left that to my surgeon's office to negotiate with insurance, so don't know the details, and for us conversions I think every case is likely different. But I did get approved! And they paid for every last cent of the surgery. I felt so very lucky. I wish you the same success!

thank you for responding!! Were there any requirements for you to get approved? What were your issues, if you don't mind me asking. I get stuck endlessly and am only down about 15 pounds since my surgery almost two years ago. I'm nervous I'll be denied by I don't have a strong enough case.

Edited December 7, 2014 by ireallywannabthin

[thesuse2000 698]

I got my band (in Mexico) in 2008. I lost about 70 pounds but then It slipped just under a year out and I had revision surgery in 2009 (in the US, covered by Cigna). But after the slip I could never tolerate it being tight enough to be effective. My major issue was night reflux - I'd inhale fluids coming up in the night and wake up choking. It would take a while each time to cough up all the fluids. My husband was so worried that I'd suffocate in my sleep. I wasn't that worried about that because each time it happened I would sit right up and be wide awake, but it was a nightmare, especially when it happened multiple times a night.

I spent a couple years going back and forth with fills and unfills, but eventually just gave up trying to tighten it - and gained back all the lost weight and then some. I didn't start seriously considering the sleeve until my BMI was back up to 41. I don't think insurance would have covered me if it was below that, but not sure.

They had me do a 3-month supervised diet. And I got some tests done. I had some esophageal dilation, and the history of the reflux with the band - which were part of the insurance application. Plus I was told that the fact that I did lose well initially with the band might help my case.

I just don't know more about cases like yours. I know that your experience is very common though. I hope your surgeon's office can help make a case for you!

If insurance didn't cover my revision I would have gone back to Mexico to do it. I know that's not something everyone is comfortable with, but I had a great overall experience with Dr. Ortiz at the OCC.

[ireallywannabthin 286]

I got my band (in Mexico) in 2008. I lost about 70 pounds but then It slipped just under a year out and I had revision surgery in 2009 (in the US, covered by Cigna). But after the slip I could never tolerate it being tight enough to be effective. My major issue was night reflux - I'd inhale fluids coming up in the night and wake up choking. It would take a while each time to cough up all the fluids. My husband was so worried that I'd suffocate in my sleep. I wasn't that worried about that because each time it happened I would sit right up and be wide awake, but it was a nightmare, especially when it happened multiple times a night.

I spent a couple years going back and forth with fills and unfills, but eventually just gave up trying to tighten it - and gained back all the lost weight and then some. I didn't start seriously considering the sleeve until my BMI was back up to 41. I don't think insurance would have covered me if it was below that, but not sure.

They had me do a 3-month supervised diet. And I got some tests done. I had some esophageal dilation, and the history of the reflux with the band - which were part of the insurance application. Plus I was told that the fact that I did lose well initially with the band might help my case.

I just don't know more about cases like yours. I know that your experience is very common though. I hope your surgeon's office can help make a case for you!

If insurance didn't cover my revision I would have gone back to Mexico to do it. I know that's not something everyone is comfortable with, but I had a great overall experience with Dr. Ortiz at the OCC.

Oh wow, how are you doing now? I don't have complications like that but according to Aetna's clinical policy it is considered medically necessary if a person hasn't lost at least 50% of their excess weight in 2 years. My BMI is 46... Hopefully it all works out.

Thank you for helping

[thesuse2000 698]

I'm doing great! The experience of living with the sleeve (for me anyway) is SO much better than with the band. I don't have any issues at all associated with it. Never get that stuck feeling. Overall it just feels more natural. I just feel full and satisfied with less food - and with healthy foods. My cravings are under control (not gone, but very diminished). I think the removal of the part of the stomach that releases the hunger hormone ghrelin makes a big difference.

I've now passed my lowest weight achieved with the band and am heading towards uncharted territory. I've never as an adult weighed less than 175 (and only saw it for about 5 minutes in my 20s), so that will be a thrill to see 174 for the first time - and that's now just 6 pounds away! Not sure if you can see my signature (I know they don't show up on ipads/phones), but I'm down 84 pounds since my highest weight earlier this year. Just 25 away from goal. Overall very thrilled with the sleeve for sure! Fingers crossed you get approved - sounds like you've got a good shot!