Revision from band to VSG-United Health Care

Tracy
on 5/1/09 12:43 pm - Arlington, TX
I was just wondering if there was anyone out there that had United Health Care pay for a revision from Lapband to the sleeve? I just found out that my insurance will cover WLS, but they don't cover all. When I asked for a list she started naming off all these surgeries and I didn't have a pen to write it down but I didn't hear VSG and I know I don't want RNY. I am going to call and get a different rep and see if they will fax or mail me something but I just thought in the mean time I would  check on here to see if anyone got UHC to pay for a revision to a sleeve? My band was done in Mexico and I wasn't sure if my insurance company would deny due to "pre-existing" or what? 

Lapband 3/1/05
Lost 120 lbs-gained 50lbs back
Sleeved 6/2/09-Lost 20lbs gained it back after hysterectomy on 1/15/10

As of 11/7/2015 I have gained all my weight plus some. I weigh 313lbs. I blame it on steroid injections I received for my back, the cymbalta i am on for fibromyalgia, I was on Lyrica for 3 months and gained 30lbs, and I found out I have Hashimoto's thyroiditis as well as Pcos. I had back surgery and had to lay flat for three months which didn't help either only to find out a year later the surgery was a failure. I now have a spinal cord injury and I am in a wheelchair! So much has happened since I last visited this site. The only thing I can do is swim. I am going to try and do this at least 2 times a week and work up to more!

babsintx
on 5/2/09 3:51 am - GA
HI,

Had a band for 5 years and UHC paid for my revision from lapband to sleeve last March 2008. No appeals first try. I hear they are getting tougher and using the experimental outclause and making people go through appeals. I had all my ducks in a row before I submitted and called my case manager everyday. It can be done. I did it.

Babs

 


 

Tracy
on 5/2/09 7:40 am - Arlington, TX
THANK YOU!!! When you say you had all your ducks in a row, what exactly does that mean? This is the first time I am trying anything with insurance so I am not sure exactly what they will need? I have not gone to a PCP for nutrition or weight loss but it is in my record that I complained about my weight every time I went. Right now I have a BMI of 35, and I am guessing they will need one co-morbidity. I have not been diagnosed with sleep apnea yet but my husband says I definately stop breathing at night so we have started the process of getting a sleep study. Did you have to prove one co-morbidity or did your surgeon take care of all that? 

Lapband 3/1/05
Lost 120 lbs-gained 50lbs back
Sleeved 6/2/09-Lost 20lbs gained it back after hysterectomy on 1/15/10

As of 11/7/2015 I have gained all my weight plus some. I weigh 313lbs. I blame it on steroid injections I received for my back, the cymbalta i am on for fibromyalgia, I was on Lyrica for 3 months and gained 30lbs, and I found out I have Hashimoto's thyroiditis as well as Pcos. I had back surgery and had to lay flat for three months which didn't help either only to find out a year later the surgery was a failure. I now have a spinal cord injury and I am in a wheelchair! So much has happened since I last visited this site. The only thing I can do is swim. I am going to try and do this at least 2 times a week and work up to more!

babsintx
on 5/2/09 1:03 pm - GA
Hi Tracy,

I had a two level cervical fusion and it was possible in the future that I would need NSAIDs so malabsorptive procedures would not be a good choice for me. I had a history of band related complications that ranged from a partial prolapse, chronic GERD, pspeudo achalasia of the esophagus, dysphagia and late complications of gastric banding, so another band would not have been an option either. Plus I had documentation that I was successful with the band prior to the slippage, so a restrictive only procedure worked well for me and the problem was device failure. I was vomiting daily due to the slip and could no longer swallow properly. I dont know why you need the band out. DId it slip? Is it device failure or compliance issues that are causing the regain? Just wondering . It does matter. PM if you need more information.

Babs

 


 

Zee Starrlite
on 5/4/09 2:58 am
OMG Tracy!

How are you?  I think we were banded at around the same time.  You had ridiculously amazing success.  I wanted to be like you but my band didn't cooperate.  I didn't do well with my band until the 3rd year.  I can't believe that you are having to revise.

Good Luck with everything.

Leila


3/30/2005 Lap Band installed  12/20/2010  Lap Band REMOVED  
6/6/2011 Vertical SLEEVE Gastrectomy

Ca_girl
on 5/4/09 8:48 am - McKinney, TX
Hey Leila...
Hmmm, I'm putting in for a revision from Band to RNY - Just made my 2 year and I would consider it a failure. Can you tell me a little about why you didn't have sucess until the 3rd year? Were you doing something different now or did your fills kick in?

Just curious,
Adrianna
Tracy
on 5/4/09 10:19 am - Arlington, TX
Hey there! I think I remember you!! LOL my memory is so terrible. Yeah, my band was actually great for me and I did well for hte first 2 years. Then I am not sure what happened, probably a combination of things but I know suddenly I could eat more than I was supposed to. The last time I went for a fill with my doctor he was shocked when he didn't pull anything out. There was nothing in there. I might have a slow leak, I am just not sure what is going on. I know I can eat though lol! I am just tired of wondering what is going on in my tummy so I decided I wanted to get the sleeve. No more wondering! Plus I really like the idea of feeling actually full and hopefully I will be lucky and not be hungry as well. You look great by the way!

Lapband 3/1/05
Lost 120 lbs-gained 50lbs back
Sleeved 6/2/09-Lost 20lbs gained it back after hysterectomy on 1/15/10

As of 11/7/2015 I have gained all my weight plus some. I weigh 313lbs. I blame it on steroid injections I received for my back, the cymbalta i am on for fibromyalgia, I was on Lyrica for 3 months and gained 30lbs, and I found out I have Hashimoto's thyroiditis as well as Pcos. I had back surgery and had to lay flat for three months which didn't help either only to find out a year later the surgery was a failure. I now have a spinal cord injury and I am in a wheelchair! So much has happened since I last visited this site. The only thing I can do is swim. I am going to try and do this at least 2 times a week and work up to more!

Ca_girl
on 5/4/09 8:50 am - McKinney, TX
Hey there, I have a band and UHC too - I just had my paperwork submitted Friday for a revision from Band to RNY - I was told by my doctor that UHC would definitely deny VSG as with his experience they always do citing "experimental" as the cause.

I wasn't so happy with the band and "restrictive" only surgery so although I was hesitant about RNY first time around, looking at the before and after pics and considering all the complications my band has given me, RNY seems like a god sent now.

Please let me know what you find out about VSG and UHC, I'm curious.

A-
Tracy
on 5/4/09 10:23 am - Arlington, TX
I will definately let you know! I know others who have used UHC to get the VSG but I am not sure what co-morbidities they had or how many times they may have had to appeal. Looks like Babs had enough going on they approved her. I hope they will let me get it too because I just don't want to have the RNY. I might be talked into the DS though....

Lapband 3/1/05
Lost 120 lbs-gained 50lbs back
Sleeved 6/2/09-Lost 20lbs gained it back after hysterectomy on 1/15/10

As of 11/7/2015 I have gained all my weight plus some. I weigh 313lbs. I blame it on steroid injections I received for my back, the cymbalta i am on for fibromyalgia, I was on Lyrica for 3 months and gained 30lbs, and I found out I have Hashimoto's thyroiditis as well as Pcos. I had back surgery and had to lay flat for three months which didn't help either only to find out a year later the surgery was a failure. I now have a spinal cord injury and I am in a wheelchair! So much has happened since I last visited this site. The only thing I can do is swim. I am going to try and do this at least 2 times a week and work up to more!

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