Band to VSG Post-Ops HELP!!!!

I am in insurance hell.  I am trying to get approval for the removal of my troublesome band and approval for a VSG.  Some Sleevesters have posted that they got their insurance to pay for their band removal and they self-paid the difference for their sleeve.  I have called several docs and they are investigating if this can be done, but apparently, the docs I have spoken to are not familiar w/ this.  Some have said I must have a separate surgery altogether from what the insurance will pay for.  That makes no sense at all.

Does anyone know anyone who was able to make this kind of arrangement with their doctor?

Thanks   

My revision surgery (band to sleeve) was approved by United Healthcare. I was actually approved for the Duodenal Switch. My doctor told me that if I do well with the sleeve alone that I would not need the DS part. The insurance is aware that I only had the first part of the surgery, and they are expecting me to have the second part but I'd rather not go through 3 weightloss surgeries so I am trying my hardest to prevent that.

If you have United Healthcare, maybe you can do the same? Leave the second part open as a Plan B, in case the Plan A doesnt work and you still get the the Plan A paid for.

Good luck!

Hi,

I was originally scheduled to have Dr. Alvarez do my revision from lapband to sleeve, but got the flu at the last minute and went for insurance approval for the revision from lapband to sleeve. IT was approved by United Healthcare and I had it done as one surgery not two. An experienced revision surgeon can easily do a lapband to sleeve if there isnt unforseen damage that would prevent them from doing this. My surgery took 4 1/2 hours because of all the adhesions to my liver, stomach and other band damage over 5 years of a band that was too tight for my original anatomy even empty. THe procedure codes I got an approval under were: Laparoscopic removal of a Gastric Band 43774, Sleeve Gastrectomy (43659). PM me if you have any questions.

Babs

Hi,

I was originally scheduled to have Dr. Alvarez do my revision from lapband to sleeve, but got the flu at the last minute and went for insurance approval for the revision from lapband to sleeve. IT was approved by United Healthcare and I had it done as one surgery not two. An experienced revision surgeon can easily do a lapband to sleeve if there isnt unforseen damage that would prevent them from doing this. My surgery took 4 1/2 hours because of all the adhesions to my liver, stomach and other band damage over 5 years of a band that was too tight for my original anatomy even empty. THe procedure codes I got an approval under were: Laparoscopic removal of a Gastric Band 43774, Sleeve Gastrectomy (43659). PM me if you have any questions.

Babs

Hi Mid-Girl,

I had considered going back to Rumbaut, but there are several considerations.  If I go to MX, and I do have complications, I will be self pay for absolutely sure.  For some reason U.S. docs think MX docs were trained on another planet and nothing they do is legit.  I actually got better care from Rumbaut than from my docs in the US.  If I get a leak in the US, I can't plan on traveling back to MX.

Even if BCBS/PPO won't pay for the sleeve, I am fairly sure they will pay for complications.  The insurance won't pay for breast implants, but if one bursts, they would have to treat me for the emergency.  They claim the sleeve is "experimental", but BCBS has set its own precidence by approving so many...  So they won't be able to use that excuse in case of complications.

Also, On person on the board indiated she paid the difference for her sleeve and it was only $1750.  So, if that's possible, I've gotta go for it.

I agree, you have to get an experienced revision surgeon.  After much research, I decided on Gregg Jossart.  I'm hoping his insurance people can figure out how I can pay the difference and have everything in one surgery.

Thanks everyone for answering.

I believe Dr. Cirangle in San Francisco will let you pay the difference between band removal and VSG if the VSG isn't covered. And he's got some of the best experience with both revisions and VSG. Worth calling their office. He does his own phone consults. I was very impressed.

I see you went to MX with Rumbaut.  Rumbaut is one of the two best in MX IMHO. ;o)

You know, this is where MX might be a better option for you and I'll explain why.  You would need an actual revision surgeon.  Your risk for perforation, leaks, infection, bleeding, etc., are triple with a revision from band to sleeve vs a sleeve on a virgin stomach.  You wouldn't want to go to anyone that didn't have a lot of experience with sleeves, staple lines, revisions, etc.

You can probably (quite easily) find a surgeon that will do the band removal under insurance but by the time you figure in extra OR time, hospital time, meds, and potential for a complication you are probably better off going to MX and paying cash.

What if you have a leak?  It won't be covered under insurance because they don't cover the sleeve.  You could be talking weeks in the hospital, etc.  That would all be self pay.

If you go to MX most of the better surgeons do not charge for complications.  If you have a leak BEFORE you leave the hospital, they will cover the costs.  Rumbaut is excellent, he's an extremely good surgeon but he does charge for complications.  For revision folks he requires cash up front or a credit card with an available limit of something like $15K in case it is needed.  If you pay the $15K in ca**** will be refunded upon your discharge.  He's one of the few surgeons who does not cover complications.

But if you were to go to another revision surgeon it would be $12,500, total cost.

I would suggest finding a US REVISION surgeon and comparing the cost of what insurance will cover and what you have to pay vs. $12,500, the going rate for band to sleeve.  See which is more adventagious for you and go for it.

Sleeves are a thousand times easier than banding and more effective as well.

I don't like any of the revision surgeons in my state, I wouldn't go to any of them.  Besides, I was far too ill to wait for insurance and to jump through hoops so I self paid in MX.