Band removal denial...

[ANKPTA 0]

Hey guys, I was banded in 2008...never any problems with vomiting or reflux. Also, never lost past the first month after surgery. Began having sternal pain radiating down in to both left and right rib areas in 2012. Surgeon decided it was my gallbladder so out it went. During the gallbladder surgery the surgeon checked the band and cleaned up some scar tissue. Did well with no pain until Nov 2016. I had the lovely gastro virus and vomited 5x and since then have been having the same sternal and rib pain again. I had also had acute reflux and difficulty swallowing my meds in the morning and they felt like they were just sitting there all day. Went to my surgeon and he unfilled the band. Checked under fleuro with everything looking ok with the exception of a slight "backing up" of the barium before it continued on through the band. He told me to take Pepcid complete and return back in a month. He also doesn't perform the sleeve but I spoke with him about going elsewhere for a revision. Fast forward and he sent an inquiry to insurance to have the band removed due to my issues for a later revision to the sleeve.

In the meantime I had a consult with a new surgeon who performs all of the procedures and he wants the band out as soon as possible to allow healing before the revision and thinks I will do well with it. Well, right after I had the consult I received a denial letter from Anthem (from my original surgeons inquiry) stating that it was not medically necessary and there was no evidence that the band was the cause of the issues and basically that I suck because I only lost 35lbs with the band and have since gained it back. A week later I get another denial from Anthem from my new surgeons request for approval. This letter was slightly more positive but still a denial stating basically they need more info to prove the band needs to come out. Insurance lady, the bariatric nurse and the Dr plan to have a meeting to discuss where to go next with me and will let me know soon what's up. So here I sit in limbo not knowing if this will happen or if I have to keep this ticking time bomb in me causing me pain all of the time until something life threatening happens to it. Does anyone have any advice on where to go next? I did start taking Prilosec and plan to document the pain daily but what else can I do or suggest be done through the Dr?

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Edited February 5, 2017 by ANKPTA

[dlkumes 42]

Can you appeal. I had been denied for lap band and appealed and won. I have since had it removed and revised to sleeve. Your band needs to come out for sure. Good luck.

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[jennifer1 180]

i just got through this.. i was denied 3 times for the same reason them stating it wasnt medically necessary. my insurance finally approved me on feb 10th. my insurance company basically stated that due to my band slipping it was deemed medically necessary as this was a fault of the band and not me. Do yo u have any documentation stating any type of mechanical failure with the band?