Lap Band defect who pays???

streetmedic85 · April 23, 2008

I'm 5 years post band with little problems, until recently, had severe sharp pains in stomach, x-rays showed tubing broke off approx. 3 " from port, still waiting to see original surgeon, current insurance won't pay, who is responsible for $$$, or am i stuck with it? ANYone else with this problem?

Enchanted · April 23, 2008

After five years, there is likely no way to show the the band or associated tubing/port were defective at the time of the initial placement.

While WLS may not be covered under your current plan, this is not WLS. This is surgery to correct a problem that is causing you pain and possible internal injury. Are you sure your insurance won't cover it once they know the details?

Good luck to you.

streetmedic85 · April 23, 2008

Thanks for replying, I'm told that my insurance would (of course) try to balk at paying, so we'll see.

When My PCP called the surgeon who did my band, he was told that this was a "Common" problem for the early bands that this company makes,(BioEnterics/Inamed) and that they have a "repair kit" Also, I was told that the Hospital/Surgeon no longer does Lap-Band, just sounded a little odd to me.

lafevretj · April 24, 2008

A friend of mine had the same issue with her band. She said the pain was terrible and the surgeon wasn't going to schedule her for two weeks. She finally convinced them how much pain she was having and they worked her in the next day. Since this was such short notice she didn't receive pre-approval for the procedure (which was $33,000). Her insurance (Aetna) initially refused to pay, but she finally got everything straightened out and they are submitting for pre-approval after the fact. What I couldn't believe was the cost of this procedure was only $1,000 less than my hospital bill for the lapband. Good luck with you insurance troubles.

youknowit · August 18, 2008

hi there. update on your situation? how did this all work out? i'm still in the "have a band, have a leak, need removed" situation. i am going to try to go to my PCP and hope they will refer me to have it removed. my insurance also does not pay for WLS, but like you said... this is a complication, not WLS. -- Any advice would really help. THanks!

streetmedic85 · August 19, 2008

Well, glad you guys asked..what a nightmare. I finely convinced my original surgeon (who no longer does lap bands) to do it, he got approval from my insurance by telling them Exploratory Abdomimal surgery for abdominal pain, and fix the tubing while inside, I would be out the cost of the repair kit. My problem has been with the surgeon and his staff, he has fired alot of his staff, so one dosen't know what the other's doing, my surgery has been scheduled twice, moved to another hospital, and then they couldn't find a repair kit, this has been ongoing for three months. But, Good Luck with yous, mine will eventually work out. I hope.