One bariatric surgery per lifetime?

Stephanie M.
on 7/27/12 1:52 am

So this is from another site, I'm copying and pasting this posters OP and her second post with her insurance company's decision

This is my first post .I originally had my first and in october 2008, it was amazing. I lost 100lbs. I went from 250 to 150 and felt great until I started to get severe acid reflux. especially at night to the point of vomitting in my sleep, and occasionally aspirating. I had my first band removed in november of 2010. there was some scar tissue so my do decided to give it a rest before replacing it. In that 2 month gap of no band i gained 30lbs just looking at food. I had my lap band #2 put in January of 2011 of which I never had any luck with. Any time I had restriction i also had reflux, therefore with no restricyion i continued to gain weight another 10lbs. Finally had a barium swallow done yesterday, and found out today that it was not positioned correctly and it needs to be removed.... so either 3rd times a charm or I will be looking into gastric sleeving.

Now the outcome
So my plan to revise to gastric sleeve failed. My insurance will not cover more than 1 bariatric surgery in my lifetime. So another band it is.

Why is a second surgery to replace Lapband with another Lapband not considered a second surgery? Makes you want to punch their lights out!

6-7-13 band removed. No revision. Facebook Failed Lapbands and Realize Bands group and WLS-Support for Regain and Revision Group

(deactivated member)
on 7/27/12 2:32 am - Wiesbaden, Germany

DS on 10/08/13

My best guess is that the replacement lap band was on the basis that the first was defective in some way and caused the scar tissue. My insurance would have given me no grief about about a band to band revision but I have better sense.

Jost Dreams
on 7/27/12 3:14 am

More and more insurance companies are adding this clause which makes it even more important to chose (or choose, sorry got a migraine) the correct surgery the first time. I fought with UHC for 5 months to get my band to RnY revision approved even though the band was removed due to a slip in an emergency surgery. I finally went to my husband's employer who overrode UHC's decision after I explained to HR.

Moral of the story.....since the band has a questionable success rate and the inclusion of the one surgery per lifetime clause....pick the correct surgery the first time. The second one will probably be self pay.

Bette B.
on 7/27/12 5:30 am

Lap Band on 12/02/03

Insurance companies change their coverage almost minute to minute. It's certainly possible that the "one WLS per lifetime" thing shall pass, too.

Banded 10 years & maintaining my weight loss!! Any questions, message me.

Stephanie M.
on 7/27/12 5:37 am

I get the "one surgery per lifetime" clause, what I don't get is that they WILL pay for a second band surgery, but not a revision (no hardware) to a different surgery...it doesn't make a lot of sense, since they all have similar costs and the band has high follow up costs.

6-7-13 band removed. No revision. Facebook Failed Lapbands and Realize Bands group and WLS-Support for Regain and Revision Group

Bette B.
on 7/27/12 5:46 am

Lap Band on 12/02/03

I don't get it at all. It's not as if you get one cancer surgery per lifetime, or one c-section per lifetime. Stuff happens. If someone runs into trouble and has to get a bypass or DS reversed, do they block that, too? It's nuts.

Banded 10 years & maintaining my weight loss!! Any questions, message me.

pineview01
on 7/27/12 6:14 am - Davison, MI

Lap Band on 02/25/09

That would be using common since Bette.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

minnie_cat
on 7/27/12 7:50 am

Find out how you can appeal this...sometimes you just have to be stubborn with them. Also, talk to your surgeon's office, perhaps they need to write a better medical justification. Good luck!

pineview01
on 7/27/12 6:06 am, edited 7/27/12 8:37 am - Davison, MI

Lap Band on 02/25/09

They need to see if the 'Once in a life time' has a, in I might add teeny tiny print, "unless medically nessasary".
My insurance changed to this policy in the middle of my trying to Revise. They will pay to get it out and pay to replace it. They will pay for me to fill and unfill it twice a month. But, they are saying no sleeve.
I will fight as hard as I can but may be out of luck. If my body hates this band it will hate a new one too.
I asked the head of referal why the board voted to have once in a life time. The main reason is because they are getting to many people with bands wanting another surgery.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

Cheryl N.
on 7/27/12 6:39 am - Des Moines, WA

Revision on 08/01/11

Well, surgeries are very expensive. My lapband was about 20,000? and my revision to bypass was 35000.

246 in Dec 2008 before banded 1/28/09 at 215 lbs, band crapped 9/09 at 170 lbs and struggled with it and regained to 203 revised to bypass on 8/1/11 and am very happy.

One bariatric surgery per lifetime?

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One bariatric surgery per lifetime?