May need revision; but now have exclusion any BTDT?

airbender
on 1/27/11 2:14 am

A band slippage is considered medically necessary and not WLS.  If you have another surgery, your insurance co should pay to correct the slippage, the question arises when people are sick of the band and want to revise to some other procedure.  If you have an exclusion on your policy for that then no amount of appelas will help you there. 

I would tell your surgeon to fill you under fluoro, many surgeons will not fill a previous slipped band patient as any fill that can give restriction will cause a re-slip, make sure everything is documented. 

This is not about WLS this is a medically necessary procedure to fix a mechanically induced problem, think of it like insurance will not pay for breast augmentation, but will pay for breast implant rupture surgery.  all the best to you

Sidonia B.
on 1/27/11 8:07 am
i do also have problems with my band and my asophycus... i need a convertion and my insurance denied me twice... my doctor is fighting with the insurance company saying that it is neccessary that i have the surgery from band to bypass..im hoping i do get approved my surgery was suppose to be january 25 and two weeks before i was suppose to have it they denied me i was very depressed over it....
media604
on 2/7/11 10:06 am - GA
Note - A very experienced head bariactric surgeon in Atlanta told me that in his experience no insurance company will deny a patient for a medically necessary procedure of any kind. It's just a matter of having that fact documented very well. If the procedure is medically necessary, i.e. life threatening currently or potentially life threatening or hazardous to your health you will not be denied.

By the way I am on my 2nd band, 1st one slipped, horrible reflux, 2nd one malfunctioning as well.....constantly too tight or too loose, no in between, I vomit and have pain everyday and I am loose right now, when tight I vomit 5 -6  times per day. This is medically necessary. I am after a revision as well. It is critical the office have all the info including all past operative notes, films, test, x-rays, included making a thorough and complete historical case. I many cases the insurance companies certainly do not want to replace a slipped band with another band and then risk having to replace it too as with me! So, you may get approved for a revision.

What matters, "is it medically necessary"?
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