Lap Band to grastric bybass revision denied

Hi
I just got my letter from BC/BS Federal. I was denied my revision surgery and this is why We thourgly reviewed the medical documentation that was submitted and determined that the below procedure Code 43659 was denied due to not meeting the criteria for bariatric surgery 43659 (22) Laparoscopy revision procedures due tot he fact that for the past two years my BMI has ben 35 prior to the surgery. Well I have had a BMI of 36 for more than two years and now it has gone up to 37.6 maybe I need to wear weights next time I don't know. My Dr. is appealing. No one ever said in the letter that I have had past problems such as vomiting, reflux with cough, dilation of my esophagus twice if not three times, When i vomit now I have to sit on the toilet and vomit in a container becasue I do this so hard that I lose control of both bodily functions do I need to say more, yes gross but it does happen. My weight has gone from a maintained 180 for two years to 200 pounds in the past 6 months no matter what I do the weight keeps piling back on. I am told that code 43659 is an exclusion of the contract so now what can I do? I need help and answers. Scared in Texas

im having the same problem with my insurance they denied me twice and i m having the same problems as you are witht the esophagus dialating and vometting everything i put in my mouth.  my doctor is also fighting with them saying that i  do need the surgery i was suppose to have it on january 25 and two weeks before the insurance denied me twice... i broke down at the doctors office... here i was ready to get rid of the band and have the bypass and they deny me....

I am a revision from a lapband to a RNY with Dr. Lautz....originally they denied my doctor's revision request then reversed their decision and approved it.  I had at that time Harvard Pilgrim HMO...it is my understanding that is has to be "medically necessary" which I would say it is with all your issues.  Dr. Lautz will fight for you to get your revision...you can be sure of that much!  Who do you have for your insurance carrier?

OMG>>> I almost feel hopeless right now.  We live near Beaumont TX and we have Federal Blue.
I was looking into a revision from Band to Sleeve.  I vomit everything up and can only get crappy foods down.  I just want this thing out of me!!  I hate it.   The Surgeon who did my surgery up and left the state with my records.. I have had no after care for over a yr.   

wow thats awful... in my case i have one of the best surgeons in Boston Mass... hes really good at what he does if only the Insurance would pay for the conversion.....i hope i hear from them soon....

Yes, he is the BEST in New England....I have sent many people to him from up here in New Hampshire.....it's a long lousy drive but well worth it for the best!

Have you asked your doctor if there is another code you can use??!!  There are different codes and sometimes they can slide by to insurance companies...crazy cause it's people's health but true!!