Do you have to regain to have a revison and how does this work with ins. compainies?

I'm just curious. I asked this question on the band forum and no one seemed to know the answer. I'm doing very well with my band and haven't had a single problem (almost a year out). I was curious to know if you have to regain weight in order to have a revision? I would sure hate to think they make you regain before they would help. Would the ins. even consider it if you are not obese? Just curious. It is truly my worst nightmare. I was self pay. I can't imagine ever going back to that unhealthy life ever again. I try to stay positive and take care of myself. I was just curious and would like to have some sort of peace with this fear.

Hi Bandhope,

THats a complicated question. THere a a half dozen factors which will decide your fate. What insurance company you have, what if any complications you have, what surgery you want to revise to... etc. I was a band to sleeve revision. Since I had a band slip and other issues with my esophagus, it was enough to convince insurance to do the removal, but I needed precert for the revision. My BMI was in the upper 30's at the time so I was headed back to 54 BMI and my lowest BMI was 28.7 with the band. So I had regained 60 lbs, but technically I was not over 40 or even 40BMI and I didnt have comorbidities other than I had spinal cord compression which resulted in a 2 level fusion surgery requiring that I might need NSAID's in the future. I used this to my advantage since you cant take NSAIDs with another band and you cant really take them with a RNY. So there are too many determining factors to say flat out whether your insurance will pay or not if you have complications.

Babs

It would depend on how much you weigh now and what you need to weigh to meet the requirements.  I'm not recommending this to anyone BUT my neice taught me a lesson on how to beat the scale.  She was anorixic.  She would put weights in her pants, shoes and bra when she had to be weighed and would wear her heaviest clothes.  And then when she got ready to leave the doctors office she would go to the bathroom and take them out and put them in her purse.  No one patted her down, well not at first.  If it's that you need a few pounds, why not? But if your talking about fifty, I don't think you could find a place to hide that much weight.  LOL

I know one woman who had a MGB out of state.  Her weight plummeted to 88#, and she was unable to stop losing weight.  As a result of that, she became very near death before she was revised to a VSG by a local surgeon (she did not want the RNY).  Her insurance company paid for her revision and one-week hospitalization without question.  She had a very difficult recovery period.  Now she is back to work full-time.

Like others have mentioned that would depend on many factors.  I had a revision.  My insurance companies requirements as far as revision goes was that it had to be medically necessary.  I had more trouble finding a surgeon who would consider even seeing me because I was not "40 BMI" or over.  I had gained some of my weight back from my original RNY in 2001 and I refused to gain even more back intentionally  to be considered a case worthy of taking on.  I finally found a great doctor who treats the individual patient rather then the BMI number I represent.

If you are doing very well with the lap band then why would you want a revision?

If you've not had any band issues, just live and be happy!

If you ever begin to experience issues - more than likely, as a remedy, your band will be emptied and more than likely(99% likely) you will gain your weight back and if you qualified for WLS then, you will qualify for it again .

Back to thinking about the glass half full - just accept your success and be happy.  You may be one that the band works forever with.

You look great always work to feel that way.

God Bless,
Leila

Well my insurance covered by two bands, and they are covering my revision as well.  I got down to a BMI of 32 and now I am back to a 37.  I guess they can see by two bands that it did not work but that when I started by BMI was exact ly at 40.  I also believe its the person who is requesting the approval from insurance. I was lucky and had someone who knew the right way to say things and the right information to provide.