Will insurance approve if I had lap band in 2010 removed

[Nanaoffour 2]

Hi all,

Looking into the gastric sleeve, which is what I should have done in 2010 instead of the Lap Band. My band slipped and I had surgery to correct it, but I was never able to eat without vomiting after that so I just had it removed. I lost 60 pounds successfully but the slippage and too many surgeries in a short time turned me off. Fast forward 7 years and I am almost all the way back to my heaviest weight. I am now diabetic and need to take Lipitor to manage my cholesterol. My knees hurt as well. My question is will my insurance company approve another WLS? I am 53 yrs old and will retire in 3 years. Same insurance company (united healthcare) that approved it in 2010. Has anyone run into this scenario? What were your results? Still contemplating...

[MissKay 329]

If it was removed due to complications like that, and you check off all the qualifications for this one, I don't see why not. However, it's something to discuss with your PCP and maybe even call your insurance provider directly and have a discussion with them. It's not like you had it and just removed it because you 'felt like it'. It was making you sick, and that's not a way of life that anyone wants to live. One would hope that wouldn't be held against you.

[rosstheboss 21]

It's difficult. I was banded in 09. I've kept off 50 lbs. but it's been a struggle. I have had fill put in and out so many times I can't remember. Ins will want to see compliance and if you gained that say you were not compliant. Many dr mine included are doing the sleeve for $10,000 all inclusive, hospital etc. with 3 yr follow . My ins is covering a revision but I have Years of compliance history even then it was denied at first. So ask your dr about private pay especially for revisions.

[rosstheboss 21]

Hi just came from dr to schedule my revision. Actually he was asking me about what I sent to get them to approve. It is hard. I later was told they sen 160 pages of documentation. And yes they check off from there list. For me after the rejection and Pier review they questioned a year that I had not seen the Bariatric Dr. But I had other dr notes and pages of compliance records.

[rosstheboss 21]

Ins may pay for removal which is easer to justify but you may have to cover revision

[Pants2830 13]

Was banded 2012. Now 2 days from sleeve all approved by my insurance after doc did a peer to peer.

[lindabalseca 373]

On 3/1/2017 at 10:31 PM, Nanaoffour said:

Hi all,

Looking into the gastric sleeve, which is what I should have done in 2010 instead of the Lap Band. My band slipped and I had surgery to correct it, but I was never able to eat without vomiting after that so I just had it removed. I lost 60 pounds successfully but the slippage and too many surgeries in a short time turned me off. Fast forward 7 years and I am almost all the way back to my heaviest weight. I am now diabetic and need to take Lipitor to manage my cholesterol. My knees hurt as well. My question is will my insurance company approve another WLS? I am 53 yrs old and will retire in 3 years. Same insurance company (united healthcare) that approved it in 2010. Has anyone run into this scenario? What were your results? Still contemplating...

i was in the same exact situation. i had band removed in 2010 and just had my sleeve 8/9/17. i am 50 and had most co morbidities