Will I get approved for revision from RNY to LapBand?

I am 3 years and 3 months out from RNY - I lost 113 pounds, got pregnant, had a baby and am unable to lose any more weight - keep gaining.  Doctor has advised me that my stoma has stretched significantly so food just falls through.  My BMI is 31/32 and I fear I will never be approved for the revision.  I don't want to gain all my weight back!!! Anyone ever been approved for a revision with a "mechanical failure" like stomal dilation...with a BMI of less than 35 or 40? I'm only 5'3" and still weigh 180lbs - too much!  My ideal weight per the charts the Dcs go by is 119-127lbs for my height and frame size. Please, can anyone give me any hope of an approval from Cigna?

I hope this helps ....Go to www.cigna.com then  go to the hyperlink (and follow the hyperlink chain)> Health Care >Physicians, hospital administrators and other health care providers > Medical > Coverage Positions/Criteria > Medical Index>then scroll down to  Bariatric Surgery – (0051) .. you will find a 23 page report entitled Coverage Position Number: 0051 CIGNA HEALTHCARE COVERAGE POSITION Subject Bariatric Surgery Good Luck!

I just had my rny pouch banded on November 13th due to stoma dialation. I was 390 and lost to 220 or so....got preggo, but lost all my preggo weight...but gained slowly about a year before my baby and continued after I lost the preggo weight and held for a few months. Anyway, I had to jump through a few hoops, but nothing terrible. I got approved, but I didn't have Cigna.

Paula - Congrats on your revision.  How was the recovery (compared to that of the RNY)?   Cigna is saying that I have to have a 6 month supervised diet and exercise program.  My doctor has submitted all information from all followup visits I had with him after my RNY - but they are not considering that a  mth supervised diet and exercise program.  My Dr gives us diet guidleines, and exercise guidelines and we had to go back for routine follow ups from the surgery and he documented everything at those visits.  I don't understand what Cigna wants me to do.  Did you run into this?  What kind of requirements did you have?  And who is your insurance company? My original surgery was done when I had BCBS - NC, and actually, I am getting ready to go back to coverage with BCBS-NC with my new job.  I wonder if I would have less problems with a revision going through the same insurance.  They should have documentation of all follow up already, I would think.  What do you think?  Thanks for your reply!  Keep me posted on your progress!  Take Care and "Happy losing", Jennifer

This surgery was a breeze compared to my open RNY since this was Lap. I won't say it didn't hurt, but it was WAAAAAAAAAAY less painful and I was able to get up and go pee on my own while I was in the hospital. I did have to stay a night though because when they got inside me I had TONS of adhesions that they had to cut through from my RNY. I had Care Choices PPO with my RNY and they paid for everything and I was approved in less than a week. This time I have AEI and they have  a written exclusion. Basically I wrote a 4 page typed "poor me" letter, my new surgeon had a phone conference, I had to have a new psych eval, I had to come up with 3 letters from my chiropracter, my podiatrist, and my general practitioner, plus I had to get copies of my medical records from the last 5 years to show documentation of my weight. Thankfully those included my high weight, post surgical weight, re-gain, and multiple attempts with diet pills. It wasn't exactly a breeze, and it took a lot of work to gather all that stuff, but from start to finish I want to say it was a month and a half to approval.  I will say that being two weeks today I have only lost like 3 pounds. I went in at 261 and was 258 this morning. I hear that Lap people lose a lot slower- like 1 lb a week, versus RNY where I lost like a pound a day- and that revision people lose slower. I am hoping it speeds up when I am able to get a fill though. :-) Good luck to you, and CONSTANTLY check up on  your insurance company because at least THREE times my surgeon's office gal faxed the wrong number and if I hadn't been a pill and stayed on them, I wouldn't have had surgery as quickly as I did. I paid my max out of pocket this year with my son (labor and delivery fees) so I HAD to get this done this calendar year to avoid paying the max next year, which goes up to $4,000!!!