If your insurance is denying your band to DS revision request--

I just wanted to post this info because I know there are some frustrated bandsters out there who want a revision to the DS but their insurance is denying them. (I also posted this on the DS board.)

My insurance (BC/BS of AZ) denied me 4 times for a revision because it was not found to be medically necessary.  I could get into the laundry list of reasons that's not true, but I'm sure you all know the typical complications. 

I had had enough so I decided to apply for the DS and JUST the DS and see if they'd approve me, and they did.  So I worked it out with my surgeon to self pay the band removal portion of the surgery and let the insurance company cover the rest.  As much as it SUCKS to have to self pay any portion of it when it SHOULD be covered by my insurance, not having to deal with the back and forth, the appeals, the fighting, the waiting, the crying when it gets denied again is SO worth it. 

Just as an example, St. Luke's hospital is charging me just around $3,700 for my out of pocket self pay cost for the band removal.  Then my insurance responsibility is about $1,200, so my entire out of pocket expense is going to be around $5,000- assuming nothing more needs to be done during my surgery.  It's going to hurt my bank account, I'm not going to lie, but $5,000 for a 2nd chance at life, to accomplish all my WLS related goals, to finally have this CRAP band out of me once and for all...TOTALLY worth it! 

18 days until I join the dark side! 

Hi Step

Thanks for posting this information.  I am going through the appeals and nonsense with the insurance right now.  This will be my next option if I get denied by the Appeal board.  BCBS makes me so sick I swear but im going to be positive about the whole thing. 

Oh I'm with you, it is so beyond frustrating!  It's very hard to stay positive but you're right, you've gotta try and just keep moving forward.  In my own way I felt like doing the partial self pay was my way of sticking it to them and saying "well if you're going to deny me I'm going to do it anyway and still charge you for most of it!"  But really, the small amount that it costs to remove the band, the $3700...they're taking so much time and effort for $3700????  To an insurance company that's nothing, and to waste so many hours of so many different people's time over that just irks me to no end.  But oh well...staying positive ;)

Stephanie,

Thats exactly how Blue Cross Blue shields of NC did with mine.  They approved the RNY but not the band removal.  My surgeon accepted the amount insurance paid and I did not have to pay the extra cost thank GOD!!.  The hospital billed the insurance but they could not bill me for the extra operating time.  They had to accept what insurance paid!!

Atleast your getting it out!!



Tamara

Unfortunately, I had to delete this post due to privacy concerns.

 OMG- What a GREAT idea. I've been denied several times for the band removal becuase there is "nothing mechanically wrong with the band" (except that I throw up daily). GREAT IDEA. I'm definitely going to try this one!

Good luck :)  It's a tad on the expensive side but it is better than being a complete self pay.  And I'm also going to have my surgeon make note of ANYTHING that might be out of the ordinary that could have helped the band fail.  If he finds anything at all I'll be re-submitting that information to my insurance to appeal yet again for reimbursement for my surgery.  Probably won't work, but if I can recover any of that money I'd be pleased a*****h! :) 

What doctor will be doing your revision? I have the band, and this past week I have been doing some research on getting a revision and I am thinking about getting the DS done. I am just not sure on which doctors are out there here in Phoenix that do this surgery. I have Aetna and I was ready their policies and I am hoping I wont have a problem getting approved.
Good Luck to you

Thank you :)

I am having Dr. Husted do my revision.  Let me say right now- the "H" word is pretty tabboo on this website due to him moving around from practice to practice some years back.  Regardless of his moving around (which he explained to me in a very understandable way) he is a VERY good surgeon and even the people who have had complications have said that he is very talented and caring.  He's training Dr. Juarez right now at the Bridges center at St. Luke's.  He will be splitting his time between St. Luke's and a practice in California.  But Dr. Juarez has been doing DS's too so he'll be able to go off on his own soon.  Dr. Blackstone has also been doing DS's since November.  I've heard some people say that Dr. Schlesinger is doing DS's also, but I'm not sure about him, I have no opinion.  If you ask any of the vets, they will tell you to fly to CA and use Dr. Keshashian or Dr. Rabkin, or fly to Texas and use a suregeon there.  They will tell you to use anyone other than any surgeon in AZ.  I have spent a great deal of time talking to Dr. Husted and I feel absolutely comfortable with him as my surgeon.  Please feel free to private message me if you want more information or if you have questions :)  Best of luck!!  I cannot WAIT to have this band out of me and get back to actually losing weight!

Unfortunately, I had to delete this post due to privacy concerns.