Isn't a failed lap band proof enough of "attempted weight loss"?

Also posted on the Main Board...

Ok, I just got off the phone with the pre-op coordinator at my surgeon's office.  She is going to work on my insurance portion of the pre-op the next couple of days.  She was reading the criteria for a "revision WLS" for my insurance.  If it's a "failed procedure" due to lack of weight loss - I have to meet the initial criteria - 6 consecutive months of documented weight loss attempts.  Here is where my confusion and arguments come in to play - if I have had the lap band for 22 months, have had 8 fills and 1 unfill, and haven't lost 1 single pound - isn't that proof of weight loss attempts?  How can it not be?  I worked harder with this band than I ever did on Weigh****chers, Atkins, or Phentermine - the only difference was I didn't see a doctor once every month for fills - I didn't need them that often, so I don't have 6 CONSECUTIVE months of documentation.  I have had nausea and vomiting the entire 22 months, tho - which was the reason for the 1 unfill I had.  So, the pre-op coordinator was going to use the n/v as a "complication" with the band.  Has anyone else encountered this?  
 
Stephanie

I am in the same boat.  My surgeon's office told me to get a letter(not notes for 6 months) from my PCP stating that I was under her care for the pass 6+ months while I was attempting weightloss and that will suffice. My PCP looked at me side ways when I asked her to sign the letter.  I told her the situation....now before she signs it I have to get all these tests again UGH.
Now I'm trying to figure out if I want to fight for the  VSG or go on smooth sailing with the RNY.

Good luck, I didn't have an issue having my lap band removed and I assumed the no weight loss and having even more co-morbs added to the reason for removal other than just the acid reflux.  Did you ever have an endoscopy or an upper GI?  Usually if your band isn't working the way it's supposed to they try to find out why.  When I had my upper GI the person said that almost everyone shows acid reflux due to the stuff you drink before hand.  I don't know if that's necesarily true or not.  Is your surgeon's office willing to work with you on this?  A lot of it has to do with how it's written to the insurance company.  Maybe you'd get better results from your pcp.  Anyway good luck I'm kind of in the same boat when it comes to getting my revision and am very anxious myself, brandyII.

Thanks for your responses.

Although an upper GI has been mentioned more than once, no one ever actually ordered one????

Twice, though, I have went in for fills and upon withdrawing all the fluid to measure it before they give the fill - it is discovered that I don't have near as much as I'm supposed to have (2 cc's less).  I have never been given a definite reason for this - they've suggested either a leak or a "careless fill" the time before - but it's happened twice.  So, I don't know what the problem is - the fluid is just MIA every now and then!

I decided this morning that I would be proactive and anticipate problems from the insurance.  So, I wrote a letter to my lap band surgeon (he's not the one doing the proposed DS because he doesn't do the DS) explaining the situation to him and asking for his assistance in documentation to the insurance.  Hopefully, he'll help me out.  He actually agreed to do a revision to a RNY for me, but then I decided to go with the DS.  So, he knows that the band didn't work for me. 

Keep your fingers crossed for me, please.

Thanks, Stephanie

Good luck,

All though all insurance companies are different as well as situations prior to my removal and chest pains I called my insurance company because I was thinking of the DS myself and they told me that since it wasn't effective(my lapband taht is) they would cover the removal and the revision to DS.  I asked how to start the proceedure and they suggested I go through my pcp.  My current surgeon doesn't do DS either and I'd have to travel pretty far but I see where it's appealing.  Anyway good luck with everything, brandyII.

There is so much variation in insurance company criteria for weight-loss surgery. In my opinion, it makes sense for having a LapBand to count as a very serious attempt at weight loss. I'm sure many insurers see it differently, however. If you can document that you had supervision of your weight loss while you had your band, that might help. Most insurers, I have found, will not consider weight loss attempts if they were supervised by the surgeon requesting approval for the surgery.

John D Husted, MD

Dr. Husted -

Thank you so much for your response. 

I did see my surgeon quite often throughout the course of the last 2 years, for fills and such.  The revision surgeon; however, I've only seen once - met twice.  So, that may be of benefit to me, as far as the insurance is concerned, because the doctor that has done the supervision with the band is in a different clinic than the DS revision surgeon that is trying to get the approval.  That makes perfect sense that the insurers would hesitate approving surgery to be done by the "supervising" and "requesting" physician.

It's nice to meet you, in a sense, as I've heard tons of good things about you.

Stephanie