Band to Sleeve Revision Struggle with Insurance Approval

[DaniGurl87 4]

I had a successful lapband placed in 2012- I'm 5 foot 3 - I went from 230 to 145 lbs. I even went thru a pregnancy and only gained 15-20 lbs or so and instantly lost that after I had my baby. I loved my lapband. I only had about one or two fills. I wasn't a fan of the port but I lived with it. I never had any problems. About 10 months after I had my child I started having acid reflux problems and went into see the doctor oct 2016. He checked my band and stated that it needed to be removed immediately he thought it was eroded and wasn't sure.. So he removed it. We talked about revision to the sleeve. We removed it the next day. There was no erosion but there was some slippage. Then he told me to the heal and go thru the holidays and we would start the process of the revision process. So come Feb I went back in and we started the entire process with the test and insurance mess I have been thru all the appeals the peer to peer I have finally hired the lindstrom attorney. I am on my final appeal. I am sooo frustrated insurance keeps denying me (BCBSofNC) stating that I do not have the BMI. When clearly in my insurance it does not state that you have to have a high bmi for a REVISION!!! I mean I am not going to be over weight when I just had a successful Lapband REMOVED!!! Which clearly now I am back up to 200lbs ! and the attorneys are fighting that.

Has anyone else had this problem? Why is insurance so stupid? They are seriously going against their own writing word they wrote. I wish I could have gone back to that day at the doctors office and asked more questions and also let them unfill and just see how it was instead of acted so quick. but the doctor made it sound so serious and I was so emotional to lose a tool that work and made my life so great!

Now I have gained weight and depressed about it. and it has been a year and battling this stupid insurance company that can't get it thru their head - about a BMI for a revision after a lapband removal...

[breprih 96]

I am in a similar situation! I am 5ft 5in and lost over 100lbs. I went from 252lbs to 149lbs. I struggled with infertility and gained a lot back. Pre pregnancy I was about 210lbs but lost while pregnant. 1 week post par-tum I was 195lbs! The next year I fluctuated between 195-200lbs. In September I went to talk about revision and they said my BMI was too low. So, I had some Fluid removed from my band and now I'm up to 215 and I also have sleep apnea so I'm hoping insurance approves me. Insurance sucks.

[Kim D. E. 5]

I was told the insurance company will only approve 1 surgery. luckily I worked for a different Co & had different Ins. I

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[DaniGurl87 4]

I’m with different employer company (government employer now before it was a private employer ) but same insurance company though it’s so aggravating!!

[ert08 18]

I'm in the process of. I had a BMI of 34.2 (under the 35 needed) when I went for my first apt. Still had my band in will find out very soon if the insurance company approves. I finished all prior tests cardio, endo, nutrion, sleep, ultrasounds, xrays etc and on the 29th I need my gallbladder out. I also had to lose 10%of my body weight so fingers crossed. PS. I hate insurance, don't give up.

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[neenee717 37]

I just got revised and unfortunately had to qualify all over again! Doc saw I was losing weight and said to stop and also no preop diet. Bmi had to get to 35, then of course knees hurt etc in order to justify them paying for it!
I met a lady who said she had to fight for years to get them to cover her revision

[neenee717 37]

And you're right it is stupid. I have to sit 6 months gaining weight, getting depressed, knees and joints aching, blood pressure up etc then I finally qualified

[Jendkopp 62]

danigurl: did Lindstrom end up getting you approved?

[3nuthut 32]

On ‎10‎/‎19‎/‎2017 at 1:51 PM, DaniGurl87 said:

I had a successful lapband placed in 2012- I'm 5 foot 3 - I went from 230 to 145 lbs. I even went thru a pregnancy and only gained 15-20 lbs or so and instantly lost that after I had my baby. I loved my lapband. I only had about one or two fills. I wasn't a fan of the port but I lived with it. I never had any problems. About 10 months after I had my child I started having acid reflux problems and went into see the doctor oct 2016. He checked my band and stated that it needed to be removed immediately he thought it was eroded and wasn't sure.. So he removed it. We talked about revision to the sleeve. We removed it the next day. There was no erosion but there was some slippage. Then he told me to the heal and go thru the holidays and we would start the process of the revision process. So come Feb I went back in and we started the entire process with the test and insurance mess I have been thru all the appeals the peer to peer I have finally hired the lindstrom attorney. I am on my final appeal. I am sooo frustrated insurance keeps denying me (BCBSofNC) stating that I do not have the BMI. When clearly in my insurance it does not state that you have to have a high bmi for a REVISION!!! I mean I am not going to be over weight when I just had a successful Lapband REMOVED!!! Which clearly now I am back up to 200lbs ! and the attorneys are fighting that.

Has anyone else had this problem? Why is insurance so stupid? They are seriously going against their own writing word they wrote. I wish I could have gone back to that day at the doctors office and asked more questions and also let them unfill and just see how it was instead of acted so quick. but the doctor made it sound so serious and I was so emotional to lose a tool that work and made my life so great!

Now I have gained weight and depressed about it. and it has been a year and battling this stupid insurance company that can't get it thru their head - about a BMI for a revision after a lapband removal...

I was approved with UHC on my first submit. I have the lapband and esophagus issues. I went in for a fill, took a barium test and found issues with my esophagus/swallowing. Since last summer I've slowly been gaining weight. I've been eating great, excising, active, etc. EVERYTHING the same. I'm around 170 but was 135-140 since being banded (SW:230lbs) Dec 2011. My Dr. submitted me for removal and revision in early July. I was approved 11 days later for both. My insurance for the band was BCBS but UHC covers me now. I was really expecting to go through the peer to peer review. I do have high BP and now have a hiatal hernia due to the weight gain...I'm total apple shape. Stay on them! Good luck. You're doing the right thing. The Lapband is starting to show the long term affects...I wonder why there's no class action. Insurance sure knows the failure rates are at an all time high. It's even in their best interest to approve. They'll end up spending so much more, at least on me. Isn't healthcare all about preventive care? There is no way in hell I was taking it out without revising to something else. Getting to my normal weight has changed my life in ways I never thought possible. Keep me posted. I'd like to know if you win your appeal/case.