My feelings are numb

Well, I found out today that United Healthcare will not cover my revision.  Had I not done the band before they would have covered the surgery, but not the revision.  I don't know how I'm feeling about this right now.  All I know is that I have to finance the surgery and it is going to cost me $23,515 to do so.  I'm not sure how I'm feeling about all this.    I'm numb.  I guess it's back to what I originally planned on doing, self pay, but now that I know for sure that insurance won't cover it, I don't know how to feel.  It's a lot of money.  It's worth it, however, it's STILL a lot of money.  I've already started applying for financing, although I'm not quite sure how good my credit is.  I want to believe that it's good so that I can finance it without having to get a loan from the house.  Man, I'm freaking numb!  I don't know how to f***ing feel about all this!!!!!!

If you have to be self pay, why not go to Mexico?  There are some seriously great surgeons in Mexico that have a great deal of experience with revisions.  I mean, this is not a procedure I would go to just anyone for... regardless of country.  But there are some superb surgeons in Mexico that would be less than half the cost of what you are looking to pay in the US.  You might qualify for a smaller loan without having to use your house. When you have had a band there are a great deal of adhesions (something we want with a band, we don't want it without a band.)  The adhesions can potentially cause more complications therefore you really want someone experienced in revisions. I feel for you, I have a band.  I can't say I regret having WLS but if I had it to do over again I'd get a sleeve, not a band. Good luck to you!

Hi Midwestern Girl, As a matter of fact, going to Mexico is what got me into this place.  I was also a patient of Alberto Aceves.  Great doctor, but impossible for me to get aftercare in Miami.  I can get fills and unfills no problem...but the actual aftercare?  Nothing.  Now I'm stuck with a band I can do nothing with and it's the reason my insurance won't cover the revision.  I already spent too much money going out of the country...I'd rather spend the money locally where I can get follow up care without having to travel outside my area.  With my medical conditions and results after Mexico...I am going to stay local.  But thanks for responding.  Continued good luck with your journey.  Say hello to Nina for me if you speak to her. -Maria

If your insurance covers revisions they cannot say that since you had surgery in Mexico they will not cover it.  They aren't being honest with you.  Either they cover bariatrics or they don't.  It does not matter where you had your original surgery. What is wrong with your band?

Hi FLor,

I am a revision from lapband to sleeve. I was reading your story. I have United Healthcare PPO and I was able to get them to pay for the removal of the band and revision to a vertical sleeve gastectromy which is even harder to get an approval than a RNY. Dont despair. You can appeal and win. If I were you, I would go to Dr. Michel Gagner at Mount Sinai in Miami. He is very talented at revision. Email me if you would like some help.

Babs in GA
334/226/150

Hi Babs, I've heard so much about him, however, I cannot get his local number only the one he had in NY.  Do you per chance have it?

What exactly does your policy say?  Have you submitted for it to be covered or just had someone at the insurance company tell you?  Did you have a look in your summary plan description to see what is covered and what isn't? Are you planning on a RNY or DS or ??  As you have probably read on this forum, it's vitality important to chose a VERY experience revisional surgeon.  Revisions are so much more complex surgeries than first surgeries. Self pay can be a good idea if you don't have any other choice, but you should look into a rider in case you have complications or have to have additional tests etc, because your insurance company most likely won't cover those complications. Good luck!

Hi. I was searching around and found this info on another post. Good luck. Dr. Michel Gagner, FRCSC, FACS
Chairman,
Department of Surgery
Mount Sinai Medical Center
4300 Alton Road
Miami Beach, FL 33140
Telephone: (305) 674-3906
Fax: (305) 674-3916
http://www.msmc.com/
[email protected]
[email protected]

Thanks a bunch!  I just sent him an email, hope it pans out!  God bless. -Maria

If you can show medical necessity, you have grounds to get your revision. What is your situation? I was prepared to sue for my revision (which was indeed medically necessary) just as I had for my first RNY.  Fortunately, I didn't need to do so, but I was ready. www.obesitylaw.com Consultations are free.  I do not work for them, am not asked to endorse them, and receive nothing for doing so.  I simply know that what they do works.  My first lawsuit cost me less than $500 (yours may vary, but I think the highest fee for representation on a complication medical insurance case is $1,100).  Obesity law is ALL that they do.  Walt Lindstrom is an attorney who had to sue his own insurance company to get WLS, and it transformed his practice.  They are also very fine folks. Do not give up.  Explore every avenue.