What a the steps for insurance to cover band to RNY revision?

[Pinkgirl1234 761]

I am beyond miserable!

The band was the worst thing I ever did to myself!

[losing_the_band 133]

First, you have to look at your insurance requirements, to see if there are any restrictions regarding a second WLS. Then, visit a surgeon (look for one that is highly experienced with revisions) to find out the status of your band, whether it has slipped, etc. Make a note of all possible complications that you've experienced. In my case, I had severe GERD because of the band and couldn't tolerate any Fluid in the band at all. I was also on my second band because my first one had slipped badly and had to be replaced. Make a note of any obesity-related comorbidities that you may still have or that have developed since having the lap-band.

I'm not going to lie to you, it can be an uphill battle to get a revision, unless you're experiencing something urgent like a slip or erosion. Generally, even if your insurance allows it, you'll have to meet all of their requirements for WLS again, and even then, you might have a fight. I'm having my revision to RNY tomorrow, and it took almost 8 months for me to get approved by my insurance, since I had to meet all the requirements again AND fight them for 3 months for approval, since they were trying to deny me because there wasn't a "technical malfunction" of my band.

[Pinkgirl1234 761]

Yes that what the clause in my insurance states"technical " failure!What does that mean?My band from what I can tell has not eroded.The CT scan indicated a mild hiatal hernia.What procedure detects erosion?

Had an upper GI with barium....severe reflux.scheduled for an endoscopy and the surgeon is going in to u fill the band next week.

My comorbities: post metatastic breast cancer with a high risk of reoccurrence because of weight gain...got a letter from my oncologist,PCOS,insulin resistance,pre diabetes,high cholesterol,and disc degeneration /osteo artrithis. at risk for heart disease stated as a result of the ct scan.

Got a note from my gynecologist stating the PCOS and insulin resistance/pre diabetes.

[Pinkgirl1234 761]

And....I will see my doctor on a spit of the dime and she knows that this must happen...very supportive.

[losing_the_band 133]

Technical failure would be a slip, erosion, pouch dilation, etc., for the band.

If you've got Cigna, that's the insurance I have, and I eventually won my appeals after my surgeon did a peer-to-peer with their medical director. Like I said, even though my insurance required a technical failure of the band, I was still able to get my revision approved without one. It just required more work to get it approved.

[Pinkgirl1234 761]

Thanks I have 3 doctors on my side PCP,Oncologist ,Gynecologist.They all have recommended this for me...