Band out. Round 4 with insurance

[km30381 2]

I got my lapband in 2006 and loved it.I lost over 100 lbs and felf great. However it needed to be removed due to slippage. Medical necessity, not by choice. It was removed last November 2014. I got two Doctors opinions, both prefer to do the two surgerys seperately to give everything enought time to heal. I am now fighting with insurance company. My wonderful Doctor did have a peer to peer with my insurance company to explain why he felt I needed the revision to the sleeve. I have written 2 appeal letters and have been denied 3 time. It is now in the hands of a third party. I was wondering if there are others out there with similar storys. I am going to have the surgery regardless even if I have to self pay, which would wipe out all my savings. Keeping my fingers crossed.

Edited March 28, 2015 by km30381

[liannatx 897]

I truly hope that your insurance has to pay.

I also had to wait between band removal and Sleeve, my surgeon said that once he was in there my stomach was in no shape to do the revision at the same time. Those months past super fast though and the Sleeve surgery and recovery went smoothly. I will be crossing my fingers for you also.

[peacheeie 14]

Hi...I too had the same issue! Band out in sept, sleeved in January...major fight with CIGNA...denied 3x's even after 2 peer to peers. Hold onto hope and talk, really talk to your doctor. Wording is key with insurances...trust me! I did have a hernia though. I too had scar tissue and therefore my sleeve is larger than the normal 15%. I only have 50 lbs to loose and in 3 months have lost about 20...loss is very slow and I am frustrated but I am working my sleeve and I will not let it work me!! I am not sure if waiting would have improved the scar tissue and allowed the standard size sleeve so look into that and ask (just an opinion from my personal experience) IM me if you would like too

Dee

[LSF 264]

@@peacheeie,

I'm curious, where did you have your surgery? Did the Dr say you had a lot of scar tissue? I know we've talked because we have the same insurance

Lori

[peacheeie 14]

Hey Lori....bayshore hospital in holmdel. Apparently I had so much scar tissue that the sleeve could not be the normal size. I'm going to request the pathology report tomorrow to see how much actually was removed.

[LSF 264]

I'm curious If they can do it again to the correct size. I had minimal scar tissue and I can feel the restriction. I'm having trouble getting all the Water in though. One week I gained a pound so I said "screw it" and had 1 cup of Pasta for dinner one night. Then I lost 1.5 pound. So now I'm trying to up my carbs just a little bit. Good luck & keep me posted on how your appt goes

Lori