One WLS per lifetime covered

I was self pay for my LapBand.  My insurance stated to me that they had the same ONE WLS per lifetime plan.  My surgeon submitted it and we were both very surprised, they approved it.  They removed my Band and revised me to the Sleeve in one procedure.  The total cost for my surgery was $65K.  I paid the deductible of $1,500.00.  The lady on the phone with my health insurance insisted that since I paid to have the Band placed, it would be my responsibility to have it removed.  They then would cover my Sleeve. 

I think you should try.  All they can tell you is no, but at least you tried.

I inquired more with the insurance co. If another ins co covered it, they would cover the revision. I still have the same ins co, Also they wanted to know what problems I was having with it. Not sure why they asked that but if my surgeon submits info, maybe I would get a more clear answer. I have Carefirst b/c b/s

If it is MEDICALLY NECESSARY they WILL cover the revision. Your surgeons office will have submit the paper work with documented EVIDENCE that it is medically necessary such as hiatal hernia, or life threatening slippage.

Insurance companies just start this and I don't blame them, because SO MANY LAP BANDERS were abusing the system AND some Bypass folks , NOT FOLLOWING RULES, POOR AFTERCARE and they were revising to other procedures since 2009 AT AN ALARMING RATE.  THEY ABUSED THE SYSTEM JUST LIKE THEY ABUSED THEIR TOOL ...IT MADE IT HARD FOR THOSE WHO TRULY  SUFFERED REAL COMPLICATIONS to revise. There are some people that have had 3-4 revision surgeries. There was a poster once that had the lap band, Sleeve, RNY and the DS ALL within 4 years..

Carefirst Blue Cross Blue Shield paid for my first band in 2005 NO out of pocket cost, but this was based on my employer benefits coverage.

I've changed insurances throughout the years with my band. When I had my revision and hiatal hernia repair recently I also had Carefirst Blue Cross Blue Shield with another employer, but that employer had a EXCLUSION to Bariatric surgery, but THEY PAID 100 PERCENT for My revision and hiatal hernia repair because it was MEDICALLY NECESSARY, but they would NOT pay for a NEW weight loss surgery such as the Sleeve.

I just started a new job 1 month ago since my revision surgery in November and my new employers PAYS 100 PERCENT for ANY Bariactric surgery, so If I WANT to get the Sleeve, RNY or DS I can revise if I am not able to lose weight or gain weight back or have complications with my current lap band. Those are the option I have IF I wanted a revision surgery.

So as long as you DO NOT have any Bariatric exclusions on your employers insurance YOU CAN APPEAL 1 WLS per life time IF IT IS MEDICALLY NECESSARY....

MEDICALLY NECESSARY DOES NOT MEAN YOU ARE NOT FOLLOWING RULES -- VOMITING BECAUSE YOU REFUSE TO CHEW YOUR FOOD PROPERLY, OR NOT EXERCISING...BECAUSE YOU WILL HAVE TO DO THE EXACT SAME THING IF YOU REVISED TO THE SLEEVE, EAT HIGH PROTEINS AND EXERCISE.  

MEDICALLY NECESSARY MEANS THAT YOU HAVE A DOCUMENTED COMPLICATION SUCH AS HIATAL HERNIA, BAND EROSON, ESOPHAGEAL DILATION OR BAND SLIPPAGE.

Good luck and hope this helps.

 

I'm going through all kinds of testing right now to find out why I am in pain. I have had a chest xray, ultrasound, I have to get a cat scan and EGD. If they find my pain is band related, I was just exploring what I can do about solving my issue and still having a weight loss tool.

Its "1 WLS per lifetime" which means per insurance - at least in my case. I have that "exclusion" in my new insurance (Aetna) but had my RNY with Healthnet. I was approved in 24 hours and didn't have to wait the 3 mos.  I had a band this time.

Mine said "1 WLS per lifetime, even if I was with another carrier with the first."  I've seen this several times here.  Even some that where self-pay were denied.

Even though it was a medical necessity, I had to fight tooth and nail to get it.  Even after they agreed, they fought it being two surgeries one band out and the other sleeve.  I had to have the band removed before I could even start to fight again and go thru the whole process again.  My fight only took 5 months, some take years.