Is it a prolapsed band or herniated?

Long story, I will try to shorten: Lapband surgery 3/2006. I did quite well for 5 years, but then lost restriction. My dr, said the band was herniated, so I took meds, the herniation decreased, went back through the "filling process." Still, my stomach/band become herniated. My Dr suggestion a revision surgery to a different weightloss (gastric). I went through the whole process, now my insurance (I changed insurance in 2011 to TriCare), has absolutely refused to pay for anything for the band, no removal, no fixing, no gastric bypass because of the band (but if I never had the band, they would have paid, strange). I went back to my surgeon, he told me to appeal the decision, (which I did, but it was still denied), and this is when he scared me with the words, prolapsed band that "could" result in that part of my stomach dying off! (the part that comes up through the band). I had two flouros and exrays prior to meeting with the gastric bypass surgeon and prolaspsed was never mentioned, only herniation. I have NO symptoms at all.. no restriction either, since the band is empty. I am very nervous now, and of course I think all kinds of things are happening inside there, but I do feel fine, no throwing up, no reflux, just slowing gaining my weight back, with an empty band, herniated and possibly prolapsed band, and no insurance to correct any of it. Anybody have any opinions on this?

Did you go to your PCM? I would think that Tricare would have to pay for it to come out. They may not pay for a revision. If you can get a referral from your PCM that would be my first step. I've never heard of a herniated band, could you tell me what that is? I have developed a hiatal hernia that is in my upper stomach, but it is not on my band. So just curious. With mine they can do just the hiatal hernia repair without touching the band, if needed and tricare will pay for that. I had my UGI done on base, does that not show if it is prolapsed? Sounds like you need more info from your WLS.
I hope you get everything straightened out, you must be going through heck. Good luck.

My surgeon has sent paperwork in for an appeal (denied), so now I have to go to the next step for an appeal. From what I understand, a prolapsed band is where the bottom part of the stomach comes up through the band and if this happens, that part could die off and could cause major problems. From the last exray/flouro I had, that is not what has happened. It is herniated, which means basically a hernia above the band. Yes, it is very nerve wrecking. My Bariatric clinic is working in my behalf on the appeals... Am hoping they approve the gastric bypass, or to replace or repair the band, but in the end, I will be just glad to have the band removed.   Thank you for your input and your concern.

A herniated band/prolapsed band/slipped band are all the same thing. Something being herniated doesn't just mean having what we think of as "a hernia", like an incisional hernia or a hernia of the stomach through the opening of the diaphragm. A "hernia" is just  a general term used to describe a bulge or protrusion of an organ through the structure or muscle that usually contains it. So, if your stomach has slipped up through the band, it has herniated. A slip, or prolapse, is also when stomach tissue slides up through the band. Although, a slip can be in the other direction as well, where the band ends up riding too high on the esophagus. It is a bad idea to keep a slipped or prolapsed band, even if you aren't having symptoms currently, because it could get worse.
What other insurance were you on in 2011? Was it an employer sponsored policy that you stopped in order to change to tricare? If so, you could probably re-enroll at your open enrollment period, or even potentially keep both poicies and have the employer sponsoered plan as primary at tricare as secondary. I would continue trying to progress through the appeals process, most fights don't usually end with just one appeal, there may be further steps you can take. You might be able to get additional guidance from this organization: http://www.patientadvocate.org/

Hi Dev, thank you for the information. I received my official denial letter today, and it actually hurt my feelings. I know I am "just a case number" but I still have a family. The information my insurance company received was that this is/could be life threatening. But they want no part of the band because it was placed in 2006, before they started accepting it in 2007. Yes, the band has to come out with or without insurance... don't know how we will manage that! Thank you for the link, I sure will give it a try. Luckily, I am not sick and have no symptoms, so I am going to work real hard to save the $$. I wonder how much a band removal will costx? PS, YES, we are submitting another appeal... hopefully they will approve me.. at this point, I will be happy to just have the band removed and nothing further! Thanks again for your concern (:

 Get estimates, sometimes if you're paying cash they will make you a pretty good deal, and if it is just for removal with no installation of anything new, it might not be that bad. I think when I had to have mine repositioned my surgeon charged $6000. She found a hiatal hernia while she was in there though, so she was able to bill my insurance for repair of that, so I ended up only paying about $2000.