Insurance will approve sleeve but not band removal?
im being told insurance will cover with the right code but the ones the office tried didn't worked. They used r109, r112, and r113. All of which to my research seem to be unexplained pain and nausea. Any reason why they shouldn't be using the band malfunction code? Do they have to show proof of a slipped band or are my physical symptoms enough? I'm really close to my wits end. I've only had a couple meals pain free since January.
What are the problems your band are causing ? I'm not sure about your dr office or insurance, I'll just tell you my story... A short version .... My band started causing problems, to tight, to loose, weight gain, severe reflux, left shoulder pain ( that was present from the moment they placed the band ) I had an upper gi that showed no problems then insisted on an egd that showed ulcers and esophagitis, gastritis.... My dr office submitted to insurance and I was denied 2 times ... Then approved. In my journey I learned that everyone is entitled to 2 appeals, then if still denied.. You file a grievance...... Then if denied .....You request an external review . You can get it paid for with persistence. Don't give up. If all else fails ... Get in touch with lindstrom obesity advocates... It's worth having them on your side for a low fee they battle for you !!
Banded 6/9/09 HW 242 LW 142 Revision 198 m 1 loss 16 lbs 182. M 2 loss 4 lbs 178. M3 loss 6 lbs 174.m4 loss 4 lbs 168. M5 gain 2 lbs 170. M6 loss 7 lbs 163 M7 loss 5 lbs 159 M8 loss 1 lb 158 M9 loss 0 M10 155 loss 3 M11 154 loss 1 M12 loss 2 152 M13 loss 3 149 M16, 17 0 loss M 18 loss 4 lbs 145 (18 months 53 lbs)
Sometimes you have to really fight for a revision. The problem is... bands often times have diagnostics that show it's just peachy. In reality, it is not. The biggest problem is that sometimes they don't know what is wrong (scar tissue****il they get in there and look.
What diagnostics have you had? What did they show?
Fluro in October. Went down fine, but my stomach is slow to empty, endoscopy in November that showed nothing. My band has been empty since at least October, but do not know when as it was not unfilled by the dr. I'm now anemic and vitamin b and d deficient.
dr has added 3 meds for gerd and I'm now on metformin. I can't do much with my diet since most things I can't tolerate.
ive kept off 70lbs, so my weight no longer qualifies
I can see why they would not pay for a revision, I had a band to sleeve revision at goal but... I was self pay. But band removal you should be able to get that done. It's just going to be a battle. Do you have wls benefits? If not, that maybe why they are coding it as they are?
Vit D deficient, we are ALL Vit D deficient. 95% of the US population is very low in D and probably 100% of the non supplementing obese or previously obese population has serious D issues. Are you anemic due to the B12 issue? If so, you can take B12 under your tongue.
Exactly right. Manometry showed low basil pressure. When my band came out, dr discovered huge hiatal hernia amongst all the other damage ie ulcers. Gastris erosion lack of ability to swallow. Thickened esophagus and regurgitation Hiatal hernia and ahesions and scarring did not show up on upper gi or xray
Have you actually looked at your policy with your own eyes? Have you seen if you have a once in a lifetime wls?
Most ins co's are going to that. Not all, most. That means that if you have that clause in your policy they will only pay for another band. It might be worth checking into so you can see if that is the issue.
Call your ins co, tell them you want the link to your on line policy and look there. They are easy to read.
Oh I have spent as much time on the phone with the insurance company as I have the doctor.
i had then send me a letter with the criteria, and I meet it for a revision. The letter only mentions RNY and band, so that may be part of my issue. There's no once in a lifetime clause. That was one of my first checks
