Will insurance cover a band to sleeve conversion?

[CandaceH80 0]

Does anyone know if Blue Cross will cover conversion from lap band to gastric sleeve? I had my band placed 4 years ago. I lost 50+ lbs. Have never been able to tolerate fills. Get one, take it out, get one, take 1/2 out and so on. I haven’t had a fill in over a year due to the fear of all the vomiting, etc. A few months back I started vomiting daily. Had an EGD and surgeon removed stomach polyps. The vomiting temporarily got better. Now, over the last month, it has progressively gotten worse. I am having difficulty swallowing, severe reflux, a few episodes of aspiration, vomiting EVERY TIME I eat and occasionally when I drink. I can’t take it anymore. The last time I saw my surgeon, he was arrogant and a jerk. He’s not listening to everything that’s going on. I’ve attempted to schedule appt with another surgeon, but most say they won’t touch someone else’s work. Blue Cross paid for my band, will they cover a conversion?

Edited June 26, 2019 by CandaceH80

[GB in CA 93]

My revision from band to bypass was approved because my band slipped and I had lots of reflux. I have anthem blue cross

[RickM 1,747]

This is another of those "it's anybody's guess" things. There is a different Blue Cross organization for each state, and they will all vary on their coverage details depending upon local market conditions and state laws. Then there is a difference between individual plans, ObamaCare plans and employer provided plans - all of which can vary depending upon what options the employer chooses to buy. Some plans don't cover WLS at all (even if they did in the past) while others limit the benefit to only one WLS per lifetime.

Muddying the waters further, if the revision you seek is due to complications of a previously covered surgery, then it is not a WLS procedure but is treating that complication (it sounds like it to me, but it isn't my decision.) There should be policy bulletin for your BC policy online that spells out what applies to your policy - what they cover or exclude as relates to WLS. You can call their number, but don't take their answer as the last word, as the customer service reps have been known to be wrong. When you find a surgeon to handle your case, their insurance coordinator should be able to tell you exactly what your policy covers, as it is their job to know the lingo and understand all of that fine print.

I understand that some surgeons are averse to working on other surgeon's patients (fixing others' mistakes...) but that is not an exclusive thing. One of the docs that I associate with (he runs out support group now) does a fair number of RNY to DS conversions, which as he doesn't ordinarily do RNYs, means that he is fixing other's mistakes (as well as fixing wonky sleeves that others have left behind) so they are out there - you just have to look.

Thinking about that a bit more, if a surgeon doesn't want to revise other's patients, then he is either making a lot of mistakes himself that need revising, or he isn't very experienced in doing revisions, so you are better off searching for someone else.

Good luck,,,,