Band slipped and it has to come out

[Susiequs 0]

My daughter had a lap band done in 2008 when she was a 21 year old student on our insurance. Last month, she was visiting Scotland and got really sick. At the hospital in Scotland they did tests that showed her band had slipped and she was totally blocked. That 2/3 of her stomach had slipped up over the top of the band and they told her she had to have it out immediately. The did laproscopic and could not safely take it out that way. So they just cut it in half. They also cut the tube leading to her port. She was told that when she got home to the US she had to have it removed. She has been having horrible pains where the tube to the port is now poking her in the side. She is home and we went see a doctor. She is now a high school teacher and has her own insurance. Her insurance doe not cover bariatric surgery and the doctors say that her insurance will not pay to remove it because it's bariatric. I don't understand why not. I feel like it is no longer bariatric. It is basically removal of a foreign body. The doctor here says that by cutting the band where they did in Scotland, they have left rough edges that are going to erode into her stomach and cause major damage. They say it's medically necessary, but that they don't think her insurance is going to cover it. Does anybody have any suggestions? She doesn't have the money to pay cash for an operation (and neither do I), it's going to cost a fortune.

[lisacaron 5,075]

It makes me very sad to read this and know that your daughter is suffering. That alone should be reason enough to have the surgery. I would go to the hospital and have them x-ray and show that there is trauma going on in there and that this needs to be removed before more than pain is the issue.

It is abdominal surgery but no longer bariatric since she is not having WLS. She is not revising to another surgery she is simply having a foreign body that is causing a danger to her organs removed. A general surgeon and/or a gastric surgeon should be able to do this procedure without issue and the insurance company should not dispute it.

I would contact and visit a gastroenterologist and see if they can be of help with the insurance company.

Please let us know how things work out.

[Rizzle01 54]

You can't put a price on life. It sounds like she needs ot be admitted and have the suregery pronto!

[Susiequs 0]

We saw a surgeon at the mayo. He said that it does need to come out and for now surgery is scheduled for August 14th. And yes, it does seem to me exactly like it should be considered basically removal of a foreign body type of thing instead of bariatric. But the surgeon said that it is still considered bariatric. But he was willing to write a letter to the insurance company and push to have it covered and will file any appeals necessary. He also said that even if they have not approved it before the surgery, we can keep fighting it after the surgery also. We will also be speaking with a lawyer next week. I am hoping that since he is part of such a large organization he might get a little further. I just don't want the hospital to say they won't do the surgery because we don't have insurance.

[ERNJN 0]

@@Susiequs -- What ended up happening with this? I am in the EXACT same boat except my band has eroded so once they remove the band they will need to repair the hole in my stomach.

I was covered initially -- got the surgery based on medical necessity and it was fully covered under my old insurance. My current insurance does not cover bariatric surgery but due to the erosion, it is critical to my health that I have the band removed and my stomach repaired. I received the initial denial and we are now appealing.

I'm hoping your daughter's outcome was positive!