Lapband revision to Gastric bypass/Bariatric surgery exclusion

[hollywrites2u 15]

Hello all, I am having trouble with my band and want to get it removed. I have acid reflux constantly and I'm worried it's ruining my esophagus. I always feel like I have a lump in my throat. I was advised to remove the band and get a gastric bypass in its place so I don't gain all the weight back that I've lost and will continue to lose weight.

My presurgery weight was 315 lbs. I got down to 195 over a five-year period but I had some issues. I had a slippage a couple of years after I got it and had to get it repaired. I had an incident where I couldn't get anything down (even water) so they removed all of the Fluid. I was afraid to get it filled again. I've gained back quite a lot of weight. I weigh 243 lbs now. I'm 5-6" so I'd like to get down to around 150-160 lbs.

My primary insurance, Florida Blue, excludes all bariatric surgery. 😡 I have great secondary insurance, BCBS Michigan, that covered my original band surgery (at almost 100%). I had the office coordinator at one of the doctor's offices that I called about a consultation tell me that my secondary won't cover anything if my primary doesn't cover it because they only pick up costs after a claim is filed. This "coordination of benefits" is pretty crappy for the consumer.

I'd love feedback, especially from anyone who had health insurance issues like this or had a revision surgery to a gastric bypass. Was the band removal surgery and gastric bypass done at the same time or did you have two surgeries? I'd like to get it all done at the same time rather than have two but I've read that some doctors will only do the two procedures separately.

Lastly, I've also read that the band's "shelf-life" is around ten years due to possible erosion issues. When I originally got it, 20 years ago, I was told that it was for life but could be removed if there were any problems down the road. Sorry this is so long. 🙂

Take care, Holly

[I♡BypassedMyPhatAss♡ 804]

I had my band removed almost a year ago and I'm in the process of getting a bypass due to GERD. I never had any issues like slippage or erosion. Only the reflux that progressed to GERD. Now my esophagus is permanently altered, so my only choice to fix it is bypass.

My surgeon wouldn't do bypass at the same time as band removal because she wanted to give my digestive tract a chance to heal from the GERD. I haven't gained any weight back after it was removed. I've actually lost a bit of weight. I'm weird, I know. 😂 I think it was because I was relying on slider foods because they were easiest to eat due to the acid issues. And now that the band is gone and the acid issues are better, I can eat healthier foods like fruits and veggies that my filled band wouldn't allow.

And I have had no issues with insurance. Mine has covered all of my surgeries and will also pay for revision. I'm sorry about your insurance issues. Bariatric surgery should be covered by all insurance just like a heart surgery or knee replacement surgery.

Best wishes!

[hollywrites2u 15]

Thank you for the feedback! Who is your surgeon? I had my original surgery in Tennessee. I moved to Florida about three years ago. My former surgeon was awesome. Great job and very caring. He passed away several years ago or I'd consider going back to him if my insurance covered it.

[I♡BypassedMyPhatAss♡ 804]

I see Dr Ashley Mooney.

[liveaboard15 1,293]

i also have florida blue... they exclude bariatric surgery here in florida. no way around that. i tried. i am doing self pay here in jacksonville, fl. best is to call around and get pricing for your procedures you want. also something to consider if you have issues after surgery, florida blue will not cover any complications that come up due to the surgery.

Edited March 24, 2022 by liveaboard15

[I♡BypassedMyPhatAss♡ 804]

Jeez, that's just wrong. But I heard the same thing about surgery in Mexico. My friend had a sleeve in Mexico 2 years ago and she told me doctors here would avoid her like the plague if she ever has an issue with her sleeve. The reason she went to Mexico is she has an eating disorder (untreated) and doctors here denied her. She didn't tell me she was having the surgery until she came back from Mexico because she knew I'd give her major grief over it.

[liveaboard15 1,293]

24 minutes ago, WhispersOfAngel said:

Jeez, that's just wrong. But I heard the same thing about surgery in Mexico. My friend had a sleeve in Mexico 2 years ago and she told me doctors here would avoid her like the plague if she ever has an issue with her sleeve. The reason she went to Mexico is she has an eating disorder (untreated) and doctors here denied her. She didn't tell me she was having the surgery until she came back from Mexico because she knew I'd give her major grief over it.

yea i made sure to read all of the fine print in regards to exclusions and sure enough if you end up in the hospital due to a issue from bariatric surgery it wont be covered. so stupid. its why i went with this particular surgeon because they offer complication insurance for the self pay people.

[hollywrites2u 15]

Florida sucks! That's good to know liveaboard15. I wish I'd read your post before I wrote to Human Resources. lol I definitely can't afford to do self-pay at this point in my life. I'm going to see the doctor to try and make sure everything is okay with the band. I'll make sure to check that the insurance will cover a consult. The office told me that they won't pay for fills and they cost $150. That makes sense with what you've told me that they won't cover anything. I've heard that a hiatal hernia and problems with the esophagus can happen because of the band. I would hope that insurance would cover that!

[hollywrites2u 15]

WhispersOfAngel I thought about Mexico today if my insurance won't pay. I read some horror stories on here so that's not going to be an option. I'd never thought about doctors here not accepting someone as a patient or insurance covering it. I

[I♡BypassedMyPhatAss♡ 804]

30 minutes ago, liveaboard15 said:

yea i made sure to read all of the fine print in regards to exclusions and sure enough if you end up in the hospital due to a issue from bariatric surgery it wont be covered. so stupid. its why i went with this particular surgeon because they offer complication insurance for the self pay people.

That's really smart, and I'm happy that they offer complication insurance. I learned something new today, lol.

[I♡BypassedMyPhatAss♡ 804]

10 minutes ago, hollywrites2u said:

Florida sucks! That's good to know liveaboard15. I wish I'd read your post before I wrote to Human Resources. lol I definitely can't afford to do self-pay at this point in my life. I'm going to see the doctor to try and make sure everything is okay with the band. I'll make sure to check that the insurance will cover a consult. The office told me that they won't pay for fills and they cost $150. That makes sense with what you've told me that they won't cover anything. I've heard that a hiatal hernia and problems with the esophagus can happen because of the band. I would hope that insurance would cover that!

If they will cover the hiatal hernia repair, if you get a bariatric surgeon to do it, the surgeon might consider removing the band and doing the revision rny at the same time. Since the insurance is paying for the operating room, and all of the anesthesia fees, sometimes it's an easy way to get services done at the same time. Usually the surgeon charges the patient a flat rate that is much cheaper than having the surgery done by itself. If that makes sense...

[hollywrites2u 15]

On 3/24/2022 at 7:16 PM, BypassingMyPhatAss said:

That's really smart, and I'm happy that they offer complication insurance. I learned something new today, lol.

I didn't know about complication insurance either. That's great!

[hollywrites2u 15]

On 3/24/2022 at 7:16 PM, BypassingMyPhatAss said:

That's really smart, and I'm happy that they offer complication insurance. I learned something new today, lol.

On 3/24/2022 at 7:16 PM, BypassingMyPhatAss said:

That's really smart, and I'm happy that they offer complication insurance. I learned something new today, lol.

On 3/24/2022 at 7:19 PM, BypassingMyPhatAss said:

If they will cover the hiatal hernia repair, if you get a bariatric surgeon to do it, the surgeon might consider removing the band and doing the revision rny at the same time. Since the insurance is paying for the operating room, and all of the anesthesia fees, sometimes it's an easy way to get services done at the same time. Usually the surgeon charges the patient a flat rate that is much cheaper than having the surgery done by itself. If that makes sense...

That's a good idea! Thanks for the suggestion. My insurance should cover a repair that isn't actually bariatric surgery. I wonder if the surgeon could do a bypass and my secondary would pick it up when my primary doesn't. I'll have to research more about it. I have an appt. with a surgeon in a couple weeks. Who is your surgeon?

[I♡BypassedMyPhatAss♡ 804]

6 hours ago, hollywrites2u said:

That's a good idea! Thanks for the suggestion. My insurance should cover a repair that isn't actually bariatric surgery. I wonder if the surgeon could do a bypass and my secondary would pick it up when my primary doesn't. I'll have to research more about it. I have an appt. with a surgeon in a couple weeks. Who is your surgeon?

Yeah it's definitely worth checking into. My bariatric surgeon is Ashley Mooney with TGH.

[ardelia 41]

This is simply stupidity. Your insurance won't cover bariatric surgery, but they'll be happy to pay if you have conditions resulting from your obesity like heart attack, diabetes, stroke, etc??? WHAT IS WRONG WITH INSURANCE COMPANIES IN THIS COUNTRY? 😡

I'm sorry you're having to deal with this ridiculousness. I wish you all the best.