need your help and experience

Hi, I am an ex lapbander, I had my band removed due to slippage and adhesions 14 months ago... now I am trying to get approval for a sleeve.  I met with Dr. Kim at NEMC last Thursday and she wasn't very supportive with that decision.  She gave me a bunch of cons, and little pro's.... Of course, I believe what steered the conversation was that she said "no insurance will pay for the sleeve".... this has been her experience here in MA... I told her the reasons I felt it was medically necessary for the sleeve, she said, you can have what ever procedure you want, I just don't want you to waste your time....  I am also doing the insurance required "I can Change" program which will not allow me to be eligable for surgery before November.... If I haven't decided by then.... THEY MAKE YOU DO THE 6 MONTH PROGRAM AGAIN!!!   and mind you, for those that don't know what it is.... it is 8 phone calls over the span of 6 months.... like a coach, a 20 yo coach....    Who has had difficulty for approval, what did you do?  Thanks for your help

Hi Deb Sorry to hear about your experience.  I am planning on having a revision as well and was considering Dr. Kim since she did my friend's RNY.  I wish my doctor was doing it, I really like him but he is not yet doing it.   I'm gonna call my insurance carrier on Monday to see if they  will cover a revision for me.   I know some BCBS plans will and some won't. 

What happened with your band???   I'm sorry it didn't work out for you.  So, your friend is doing well?  How long ago did she have her RNY?

Hi Deb, I am a lapbander also having a revision to RNY this Monday with Dr. Lautz at the Brigham & Womens Hospital.  Is your heart really set on the sleeve?  I think the doctor your chose is the only one doing it around here.  I know my doctor doesn't do the sleeve. The reason I ask this is sometimes approval is "easier" if the doctors office can show medical necessity.  I was originally denied my revision and approved the following week.  My doctor's admin asst. is an insurance whiz and seems to always get approvals from what I heard.   In other words, I think some doctor's offices are seen more favorably by the insurance companies.  That's what I think. I may not be right on this but I do wish you luck with your revision whatever surgery you decide on. Valerie

I forgot something.  Dr. Looser's first lapband patient is interested in a revision too. She lost 140 lbs. but is slowly gaining back her weight.  She said she will wait to see how I do first. I was pretty surprised when I saw her last March and told her I was having a revision.  She told me she wished she had done the gastric bypass instead of the lapband.  I was pretty surprised by what she said.

Well, I love Dr. Looser, and he offered to do the bypass after my band was removed, but at 195, I thought it was a bit wreckless, of course I was thinking, now that I am down to this weight I can do the rest on my own... WRONG...  Dr. Looser said the board was discussing the future of the band with their pratice because of the number of folks not loosing enough weight.  I did well, but my esophageal issues had him stumped, and we did much joking about it... I was officially "weird"...  Keep me posted on you.  I like the sound of the sleeve because there is no touching the bowel...  Dr. Kim does the sleeve, if you self pay, because she said she has yet to have the insurances approve it, one recent woman appealled 3 times, now she is self pay...  Best Wishes!!!

What happened with your band?  Isn't your BMI too low now to have a revision covered by insurance?  If not, how is your doc's office processing it as? 

I think this is directed to me, sorry, I am aweful, and embarrassed to update my profile, it's all too depressing!!  but unfortunately, I have gained back 80 lbs, so sadly I easily qualify, it's 80 lbs I have to lose all over again.

Deb: There are a lot of people getting approved for the sleeve these days.  It may help if you can show you were successful with a restriction-only operation (like the Band).  If you post on the VSG board, there are  few people who have appeal packs they can give you. Good luck. :)

Well, thanks, yes, all my band operative pre and post have all over the place I had lost from 313 to 195...  I will post again on the sleeve board, but honestly, I'm not sure what I want now and I have to do some observations and research all over again.  I hate to sound like a sissy, because I am tough, but all this stuff makes me a little weak in the knees!!!