EMERGENCY REVISION

Well here I am less than 48 hours out of an emergency lap band revision. I have been experiencing difficult eating for two weeks now. Of course I assumed I had eaten something a little off course so I decided to switch to liquids and mushies for a couple days. On September 28th I tried to eat a taco and BOOM that was all it took!

As the week progressed I was experiencing extreme heartburn, inability to keep liquids and food down. I was slowly starving. I called my surgeon on Monday October 5th and he requested I come to the hospital right away for a barium swallow. Sure enough, worse news possible. I had a severe slip. He removed 1.4cc from my band and insisted on scheduling surgery as soon as possible. No gravity or time would allow for my stomach to return to its natural position, surgery is my only option to live.

 I decided that if I had gone this long another couple days would allow me time to make ends meet with my health insurance. I waited and waited. BCBS denied the first letter of request. My surgeon than appealed stating this was a life threatening issue. BCBS deemed it medically necessary however my group declined the procedure stating they exclude ALL bariatric surgeries. My group is my employer and it all boiled down to the coding! How can an insurance company NOT save a life when deemed medically necessary due to a fkn number, what is this world coming to?

As each day went on I was becomming weaker and weaker-barely able to get out of bed in the morning. I was severely dehydrated and ended up in the ER Friday morning. Surgery was scheduled immediately. I am in extreme pain, I am struggling knowing what type of bill I will have-I am a single Mom who cannot afford a surgery of this sort (medically necessary) without assistance from my health insurance provider who I have been paying into for 8 years now. Mind you BCBS did allow for my band to be placed.

I did not receive a new band. They went in and placed the stomach back in the correct position and repositioned the band with new sutures. I do however have many many new incisions which is very difficult for me! I am happy the surgery was a success however I am paying off a 8k lower body lift. I had one tiny scar from my lap band nearly 5 years ago. I thougth I was done with scars. My tummy tuck is now ruined.

I feel horrible, I am overly emotional and need all the support I can get....God bless!

Hello joychaser,

Sorry I don't have to much advice that will help you at this point but I wanted to say I am very sorry to hear of your troubles!  I hope you start feeling better soon.  It is a blessing that they were able to "fix" you before it was too late.  Hang in there.

I too, am in a battle with BCBS over payment on my revision now over a year old!  They payed the surgeon, the anesthesiologist, for all the testing but they refused to pay the facility charges.   Needless to say, I am appealing.  Don't give up.  Have the hospital or surgeon re-bill with the correct code if that is all it will take.  Just because it was denied the first time doesn't mean it can not be re-submitted with the correct information.   I am sure the doctors and hospital want BCBS to settle as much as you so that they can be paid for their services.  Reality is, if it is dependent on the patient to pay they know, either it will take a long time to be paid off or in many cases they don't see payment at all.  

I hope you heal quickly.  Good luck to you.

Bless your heart!!!!!

I am sorry to hear you had to go thru so much.....I happy to hear you made it out with your life....

There are places online that you can check out billing codes.....if you have any friends or family in home health or hospitals maybe they can allow you to come in and browse there coding manual and you can find that "loophole" you need....

As far as paying the bill......as long as you are attempting to pay even $10.00 a month to each one, they cannot garnish your wages or legally harrass you on the phone( you hafta tell em to stop calling you in no uncertain terms)...there is a site online re: collections programs and your legal right....

My appendix ruptured when i was 7 months preggers and many of  the bills werent covered under my insurance, even though it was life threatening....insurance is crazy sometimes, so I know a little about unexpected bills....however just before my divorce I filled bankruptcy and they are all gone now....i have since made new ones though...

God bless you and be with you.

Big Hugs,
I am sorry you have to go through this but I'm glad it wasnt any worse.  It was good that they could save your band, that is a big fear of mine and I have been seriously thinking what I would do if something similiar happened to me. 
That bites about your insurance but mine doesnt cover squat either when it comes to wls issues.  As far as your scars go they will fade with some time and I'm sure your tummy will still look nice and flat and you will be as beautiful as ever.  Try not to be down in the dumps and think about the positives in the situation.  I will be sending some feel good thoughts your way.
Take care:)

 While they are in there fixing your lapband, maybe think about getting a sleeve (VSG) done, so that you won't ever having to go through this again.   I've read about so many people having problems with lapbands after having them work just fine for many years.    I haven't read of too many people who are, say, 10 years out and still have the bands in them and working.    Maybe they're just not posting here.

The human error that caused the  procedure "coding" issue is quite prevalent.   It happens a lot!   I believe it's the reason why some patients get approved while some patients get denied for the exact same procedure with the exact same insurance.   It all boils down to the "knowhow" and experience of one of the many office girls in the doctor's employ who "happens" to be filling out your insurance forms at any given time.   Sad, but true!   It's good that you discovered the error and are correcting it in time.   These so-called "office" girls don't realize that someone's life hangs in the balance when they're putting numbers into a box on a page!!

 If the coding was the problem, you should be able to get that overturned. It was explained to me that the revision surgery that I am seeking is medically needed, and does not have to be coded the same as bypass surgery. Much like a person who has stomach cancer or an ulcer might be given a RNY bypass, for example. 

I'm certainly no expert, though, as I just got my denial letter from Blue Cross on Friday evening. My Alabama policy denies me for almost everything, so I was not surprised. I've even had them call and cancel a much needed second knee surgery the day before surgery. They had approved it, then, decided they were going to deny it. I got two denials from them when trying to get my first bypass ten years ago, but they eventually agreed to pay.

You may end up needing to get a lawyer to help you get this overturned, but I bet you can get it done. I guess it's tricky when it's your employer that's causing the issue. I guess you have already called your company's insurance department and explained the situation? If they were the one's *****jected the claim, seems like they could just make a call and get it paid for if they understood the medical necessity and that it was not done for weight-loss or for non-compliance.

Hope you get it all worked out. Sorry about the extra scars. I really do understand how awful that is! I was so vain about keeping my tummy scar free in my younger years that it almost cost me my life. I totally understand where you are coming from.

Please believe every word that I'm telling you.  I lost my band after two slips and repairs.  Whatever you do, do not get a fill of any type for AT LEAST six weeks...no matter what the doctor says.  There is not nearly enough healing or scar tissue laid down and it can tear loose very easily.  Remember, at least six weeks, preferable nine (9) or more.  You have plenty of time to lose weight so don't sweat gaining some.

Losing my band after 8 months and 55 pounds has been the worst possible experience.  I wish you the very best.