Lap Band Revision Surgery - Scheduled April 8th
My insurance approved the revision surgery and they have me scheduled for April 8th.
I was not nervous when I had my band initially put in, but now I am VERY nervous!!
I need to hear something from people that have had the LB revision...what to expect, etc?
Start Weight: 256
Surgery Weight: 248
Lowest Weight: 176
Revision Weight: 201
Current Weight: 196
Goal: 165
Never turning back!!!!!!!!
On March 27, 2009 at 8:55 AM Pacific Time, gottaluvave wrote:
My insurance approved the revision surgery and they have me scheduled for April 8th.
I was not nervous when I had my band initially put in, but now I am VERY nervous!!
I need to hear something from people that have had the LB revision...what to expect, etc?
What are you revising to? Band to band or band to something else?
I'd be fascinated to learn how you got insurance to cover a revision.
I want to revise from a lap band that has slipped to a gastric sleeve. The insurance company will cover removing or replacing the band. They cover sleeves generally but because I've lost weight and now longer am morbidly obese they tell me that we'll have to prove it's "medically necessasry" to do that part of the surgery. That seems crazy to me. Like telling someone that had a kidney tumor removed that a later transplant won't be covered because the tumor's gone. I'm assuming they're going to decline the pre-cert and am interested in ways to fight them on appeal.
Best of luck.
Britt
I want to revise from a lap band that has slipped to a gastric sleeve. The insurance company will cover removing or replacing the band. They cover sleeves generally but because I've lost weight and now longer am morbidly obese they tell me that we'll have to prove it's "medically necessasry" to do that part of the surgery. That seems crazy to me. Like telling someone that had a kidney tumor removed that a later transplant won't be covered because the tumor's gone. I'm assuming they're going to decline the pre-cert and am interested in ways to fight them on appeal.
Best of luck.
Britt
StacysMom
on 4/1/09 6:20 pm
on 4/1/09 6:20 pm
I don't know if this argument will work, but you could take the approach that if you hadn't gotten the lapband, you wouldn't have lost the weight that you have and if that lapband is removed, you will probably gain all of that weight back. You need to keep up the momentum with your weight loss and not experience regain back to morbid obesity.
So, they would either need to pay to replace the lapband or do the sleeve and the sleeve is less expensive in the long run. No fills, no slippages, no need for replacement, etc. There are probably studies out there which show band replacement statistics or the need for conversion to another type of surgery. Find them and submit them. I've read that, because of these issues, the lapband is becoming less prevalent as a WLS tool, so the insurance companies are probably already aware of this. Why would they choose to create more expense for themselves down the line?
An added bonus of the sleeve surgery is that it removes the greater curvature of the stomach where the majority of Grehlin (the hunger hormone) is produced. It has the same long term success rate as the RNY, however, it is easily revisable to the DS if you find you need malabsorption.
I also think there is a variation regarding approvals depending on which agent is reviewing your case. Sometimes, it's a matter of the attitude at that particular time and day of whomever is making the decision.
If they absolutely won't approve the sleeve surgery, perhaps you can offer to self-pay the difference between what the sleeve would cost and what replacing the lapband would cost (if cost is the issue to the insurance company).
So, they would either need to pay to replace the lapband or do the sleeve and the sleeve is less expensive in the long run. No fills, no slippages, no need for replacement, etc. There are probably studies out there which show band replacement statistics or the need for conversion to another type of surgery. Find them and submit them. I've read that, because of these issues, the lapband is becoming less prevalent as a WLS tool, so the insurance companies are probably already aware of this. Why would they choose to create more expense for themselves down the line?
An added bonus of the sleeve surgery is that it removes the greater curvature of the stomach where the majority of Grehlin (the hunger hormone) is produced. It has the same long term success rate as the RNY, however, it is easily revisable to the DS if you find you need malabsorption.
I also think there is a variation regarding approvals depending on which agent is reviewing your case. Sometimes, it's a matter of the attitude at that particular time and day of whomever is making the decision.
If they absolutely won't approve the sleeve surgery, perhaps you can offer to self-pay the difference between what the sleeve would cost and what replacing the lapband would cost (if cost is the issue to the insurance company).
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