Lapband/sleeve conversion: Will insurance cover if lower BMI?

[JamieNP 20]

HI all!

Got my Lapband in 2008 and was doing well..was down to 120 lbs. After an injury and some NSAID use, I had started having problems with irritations and the band being too tight, then no restriction when the Fluid was removed. Have gained 60 lbs and now having some of my pre band issues return, such as hypertension and sleep apnea. Have talked to my surgeon about the possibility of getting the band replaced or converted to sleeve, which would be my choice since they are phasing out the Lapband. Has anyone had this done, and if so, did your insurance pay for it? Was your BMI less than 30? Thanks in advance.

[Sophie74656 1,572]

The best thing to do is to call your insurance company and ask them

[JamieNP 20]

The best thing to do is to call your insurance company and ask them

I will after the holiday weekend. We will likely have to do some good documentation. I was just curious if anyone else had success. ( I realize that there are different variants that will impact each person's outcome, i.e., type of insurance, comorbidities, state that they live in, etc)

[duckydoom 128]

I had my band removed 2 years ago, and I'm now going in for a consultation to see if I qualify for the sleeve and what exactly I'll have to do in order to get it covered. Since it wasn't a revision at time of band removal, I'm 99% sure it's going to be treated as if I am coming in from the start. I got a modified referral for the consultation only, and was told by the bariatric case manager with my insurance that I still need to meet all of the requirements. I've got a BMI between 35 and 40, so I have to show that I still have the comorbidities.

If I had revised to bypass at the time of removal, it would have still required a referral, I just think it would have been approved without any question. I wanted the sleeve though, which wasn't covered at the time... so here I am.

See if your surgeon will submit an authorization request for a revision due to intolerance, have them slap on the other comorbidities (sleep apnea and hypertension) and go from there. You can always appeal. If you have any chart notes etc from other specialists that you've had to see, have the surgeon include those. The more information the better.