Steps necessary for insurance coverage of Lap band to sleeve

[Pinkgirl1234 761]

I need off the lap band ride.I really need Insurance to approve a revision.

I can't take it anymore....I have had this band since 2004.I have just about gained all the weight back and I am a secret bulimic because I am constantly throwing up and sliming.i want a revision to the sleeve.I don't want another needle in me...my port is always sore.I feel disgusting.I am seeing a dr in a week but in lots of pain,reflux.

What are the steps and timeline generally to get insurance approval and/or response once dr office submits claim?

[NewNewMe 277]

That depends on your insurance. I had Cigna. I had to do four months of dr assisted diet/weigh in. See a NUT, get a psych eval, and get my primary doc to write a letter that he approved. It took about 3 weeks after that to get approval.

[augkash 14]

Ask doc to check for hernia

[Pinkgirl1234 761]

For Hernia...yes something is wrong.Will do.PCP or Surgeon? does it matter who request s the test?

[Pinkgirl1234 761]

I may need to go to the ER the next time this happens.My consult is a whole week away.

[augkash 14]

I went to ER (2nd time I've been first time I had aspiration pneumoniafrom reflux) bc I woke up choking again and they did cat scan and he said my esophagus was open. So I made apt with my surgeon and he did scope and found hernia

[Jess55 97]

I'm trying to convert to the sleeve too. I also felt bullemic with the band, not the binging, but when I had Fluid in my band I was puking at most meals. My doc removed all my fluid like 4 months ago and I've still had a couple stuck episodes. My doc made me do the entire pre op testing again. Luckily they didn't make me do the sleep study again, that was awful. I just got my letter from my pcp so they can finally submit it to insurance. I'm crossing my fingers they will approve it, since I no longer meet the 40 bmi requirement and I don't have any comorbidities. We're hoping they will approve it due to complications.

[Pinkgirl1234 761]

Yes it is a vicious cycle with the band.I have never had a sleep study but as I get heavier I know I have a sleep problem.Sometimes taking my medication at bedtime is a big problem.I often wake up hours later with a sharp piercing,aching pain in my stomach .I feel like I can't breathe.I immediately have to get warmed almond milk to soothe whatever is going on.I am also itching near my port lately but it is an internal itch.It's awful.My shoulder blade is also aching(left side).I want this out! My consultation with the new surgeon is on Monday.

[katybelle7 65]

Best of luck! Luckily I'm on Medicare now which will cover the switch from lapband and to sleeve. Although I went through all the tests, psych evaluation, sleep study, etc the first time, (7 years ago), I was surprised to find out I had to go through it all over again changing to the sleeve. My band has slipped, I have had port pain from the beginning, and now have a hernia with my stomach popping through. I've finally finished all the testing for the second time and am awaiting my surgery date. It's amazing the hoops we have to jump through the second time around! Again, I hope all goes well with your surgery!

[Pinkgirl1234 761]

I see a new surgeon next week.Will update.

[hockeyfan7 249]

I threw up every single day for months with the band and I did NOT have a hernia. It had already been repaired when I had my lap band surgery.

I have Anthem BCBS and the only thing I had to do was go see a psychiatrist for one appointment. I had to do the regular pre-surgery EKG and blood work but that was a hospital requirement and everyone who has surgery has those.

[Pinkgirl1234 761]

I am interested in whether or not I have a hernia or slippage.I had a hernia years ago when I initially had the band in 2004 during surgery.I am constantly in pain around the port.I feel puffy and just miserable.Just finished sliming and puking.

[hockeyfan7 249]

My surgeon told me the pain around the port is often the port sliding over a nerve. I had that a lot. The sharp stabbing pain drove me nuts.

[Pinkgirl1234 761]

Ugh...nerve pain...can this be detected in a known test.?

[Pinkgirl1234 761]

Was just at the ER...nausea,vomiting....finally had enough.They won't touch me....the band is like doctor repellent....they did a cat scan and it noted a small hiatal hernia!!! this has to count for something.The new surgeon will be able to gauge slippage when he does the fill procedure....hopefully this will all be considered for revision.