Advise on BCBS Fed (TX) Insurance please for Revision!!!

So I had the lap band placed in 2008. I was doing great!! Lost about 100lbs. I have had problems with gurd though for quite some time. about a year ago I started to vomit every time i ate something. After several test, I found out that my band had malfunctioned and slipped. So my surgeon removed all the liquid out of the band. Since April of 2017 I have gained back about 60lbs. I was denied by my insurance company for the revision saying that I dont meet the criteria of being mobility over weight for the past 2 years. Well of course I wouldnt be because of the band.

With all that being said. Has any one else had this or some thing similar happen to them, and what did you have to do to get insurance to approve it. I am frustrated and feel like I'm at a end point with the insurance!! But yet I dont want to give up!!

Hi I also have Federal BCBS and was banded in 2013 lost some weight had horrible gerd, vomiting and painful gallstones. I had a bad slip 5/2016 and had all fluid removed once the band corrected itself I tried it again never finding any success so Jan2017 I made up my mind to get this band removed and revised to a sleeve. I started all the nutritional visits ect. had tons of documentation including a 2 year weight diary where I pretty much showed weight loss when the band worked properly and showed how I would go days upon days of constant vomiting. They originally denied my request with my bmi only at a 38 and no major co-mobids only having high cholesterol, gerd, gallstones, however, my doctor went to battle for me and they approved an appeal 3 weeks later. Don't give up start the appeal process.

Thanks for the information and I have decided to switch doctors as they Dr. Office that I was at has pretty much given up with helping me get it appealed!!!

Not giving up and hoping for the best with this new office I will keep you updated!!

Good for you I wish you the best please keep me updated!

Just a quick question,

Did you have the BMI of 38 for at least years prior to the revision surgery?

They are saying that I need to have morbid obesity for at least 2 years prior to the revision?

@krafty81 my BMI never went higher than 38. It fluctuated a lot but I never hit a 40 bmi, my doctor used my lapband struggles, high cholesterol, slipped band photos ect. to show that it was ineffective. My doctor requires a 12 month diet history journal so I had to state what I tried each month, how the weight loss/gain fluctuated I pretty much showed the times my band worked and the times it was stuck and I couldn't eat for days until I got in for an un-fill.

I current BMI is 34!!

About a year ago I was at my lowest weight but since then I've gained about 60 pounds!!

My insurance denied again saying that I haven't been comorbid obese for at least two years !!

It's so frustrating to me even though I can show proof of the band slip I have Gerd vomiting because of a defective band they're saying they won't pay for the revision because it's not medically necessary!!!

But the new doctor is going to set up for a peer to peer so I'm hoping something good comes out of this!!