Stupid effing band!/Medical Records

I have a consultation scheduled for 1/7/11 with Dr. Kerlakian to revise my band to RNY. I received my medical records from my previous surgeon today. It included the phsych eval and nut eval (pre and post op) and my sleep study info. I'm glad that I was able to see them, and didn't just wait to have the doctor's office request them.
Before I get into the real issue....I just wanted to ask/say.....how weird is it to read your own psych eval? I'll answer.....VERY weird!
Anyway........
I was hoping that there wasn't anything too incriminating in there. Aetna's bariatric surgery policy says that to be considered for revision/conversion I would have to have not lost 50% of my excess body weight after two years (and) that I had to be compliant with the original diet/exercise program. Well.......I thought I was pretty compliant, considering I lost almost 30 lbs in the first 6 months with no restriction whatsoever. The nut eval and surgeon's assessment at 1 month out looked awful, saying I reported I was having trouble complying, and that I had fast food!!!! It says I had no restriction and I was hungry all of the time. I can't believe I had fast food! I specifically remember going almost a month w/o fast food, b/c at the time I was a fast food addict (fortunately no more). I had managed to lose 12 lbs on my own, so I had to have been somewhat compliant. Either way...that doesn't look very good to insurance I'm sure. At the following surgeon's appointments he says I'm doing very  well. I'm hoping that one month appointment documentation doesn't hold me back from getting revised.

I was much more immature when I had the lap-band done. I wasn't ready. REGARDLESS.......the lap-band never provided me any satiety after a few ounces like I was promised continually. It only brought sporadic and sometimes severe pain. It's awful when you're sooo hungry and your stomach is growling, but your stupid band says your "full". Making me have pain doesn't stop me from being hungry...HELLLLOOO! I can never know when I'm going to get "restriction". It's either I can eat a hearty meal, or I'm in pain from two bites of food. It's like playing the lap-band lottery. Let's give the wheel a spin....is Amanda going to be able to eat this sandwich....or is she going to have awful pain and get the hiccups for an hour? This surgery was not right for me, and with what I've seen, there are very few people it is right for.

I'm much more mature now, my life has completely changed, and my eating habits have changed for the better (not fast food addict, no binge eating). I am certain that I'm ready. I hope that factors into the insurance's decision.
Sorry.....I know this probably sounds like a jumbled mess. I just had to get it out there!

So much of your post could have been written by me. It didn't affect my revision.... as I'm revising the 11th of Jan.

Good luck with your consult.

Teri

Did your insurance approve your revision or are you self paying. I am looking at a band to rny revision and just got denied by my insurance. They said that I had had my one lifetime bariatric surgery. Does your insurance have the same stipulation and if so how did you get it covered?  Any help would be appreciated.

Steph

Unfortunately, it sounds like you have a clause in your plan that does not allow for a revision. I don't believe it's even debatable or appealable. I'm sorry : (.

Most plans don't allow for even one wls. It depends on your employer and what they pay for. More recently, some of these policies have added that clause that you speak of to keep premiums down.

Steph


Some insurance companies have that they will only pay for 1 bariatric surgery/lifetime.  If that is the case then the insurance can deny you. 


Tamara

 
There is really nothing to appeal.  An appeal means the ins co is wrong in some way, they claim to cover something that they are not.  They already came through on their end of the deal, they paid for your one WLS in a lifetime. :o(

Welcome to the world of self pay.

Sorry you are going through this.  This is why some of us post on the band board warning people that the band is not forever.  Many ins co's are going to the one WLS in a lifetime policy.

Thanks, terilynn! Good to know it didn't effect yours. I'm just going to try to put it out of my mind...worrying won't accomplish anything! Best of luck with your revision!

I think you should be ok.  You were trying to get to know your band. Just cross the bridge when you get to it. I think my expectations of the band were very different then, and so if I had to do it all over again I would not choose the band for me. We are going to think positive and hopefully the Dr. you see will know how to get this approved for you.   

Thanks, Candie! Only a few more days for you!!!

I think you are probable reading too much into the notes. 

I had lap band placed January 2009.  I did good the first 6 months also.  I even seen a registered dietician because I was not losing after 6 months.  I had problems getting to restriction because of my band and the esophagus.  My esophagus was not emptying into the stomach like it was supposed to.  They couldn't tighten the band anymore and I started having spasms and pain.  I only lost 54 pounds with the band.

When I had the bypass on October 2010 I have already lost 31 pounds.

Look at the bypass as a do over. Figure out why you failed with the lap band and do it right this time.  I meet with a psychologist monthly and am really greatful for her insight.   Even though I did really good with the band there was still a lot of things I could have done better. I try not to eat fast food.  I cannot eat sugar and I can't eat a lot of carbs or I will be sick.  Each day is different.

Tamara