Question/Poll for those whose INS paid for a band to rny

I have an "appeal" hearing tomorrow to convert my lap band to an rny.  my ins company does not have a policy for those who need revisions.  They continue to treat me as if I am a brand new person coming in and looking for an rny -- this would not be the case.  I have developed severe acid reflux w/the band and it develped into complicated pneounmia with fluid on my lung last year.

I've complied w/their requests and seeked out their doctor.  I however  in my personal opinion is baffled that Sparrow Hospital and the doctor are considered a baratric center of excellence.  I've been told that I'm lying to him, he has taken OLD medical information off of my charts w/o confirming, lied to my insurance company, when he told me that I never had "signs" of acid reflux or a hiatal hernia that I was crazy (yet three other doctors have found both to be true) and when i responded and told him that there was something wrong he told me to "cool" down, his office staff can't keep track of the patients (when i called to tell them i was going to be 10 miniutes late they told me they had me marked down and already seeing the doctor) and the "health services" that this hospital used refused to call me back for almost 2 weeks until I had to get a supervisor invloved.  -- mind you i've had MY dr for almost 2 years (and thankfully this is not the guy)

So here is my question for those: When your doctor deemed medically necessary (like MY doctor has stated) that there is a problem w/a band and would like to convert it to a different surgery what steps did you potentially have to go through w/your ins company and did they have a policy in effect like MESSA, BCBS of MI and Priorty Health in MI do (the first two are on a case by case situation and the last one has a policy stating if deemed medically necessary they will cover a revision)

My insurand paid for the revision from band to bypass.  I had similar medical issues as you.  I think each insurance company has different criteria.  Good luck; I'm sure it will be approved.  It is a medical necessity.

maryjo

My insurance also paid for my band to bypass.  It was a non-issue.

Aetna  approved my second band removal  and revision to RNY within hours of request.  The doctor's office submitted the request.......I never talked to anyone at all. 

Same with the removal and replacement of my first band......non-issue wth BC/BS.  Again, the doctor's office (not the same city) took care of all the paperwork.

My insurance paid for it no problem.  Mostly because after 5 years with the band, I was still a type 2 diabetic and it was getting worse, not better.  So, therefore, it was deemed medically necessary.  I'm sure you will be approved because a hiatal hernia seems like a medical necessity to me.  Continue the fight!!