What deems medical necessity for a revision when trying to go from lapband to VSG?
I have found out that my insurance, Cigna Open Access Plus, will pay for a revision if deemed medically necessary? What does that consist of for a lapband. I'm going for a fluroscopy on Friday. Would 7 years of fill/unfill pain/throwing up everyday because of not being able to find restriction qualify me or would the xray have to show slip, pouch dilation, or similar?
I think it is up to your insurance company. You should look at you policy.
I have to prove medical necessity as well. (you can look in my profile as well) And I have to re-do some tests in order to prove that. When we submitted into my insurance company, the reports did not support mendical necessity. This time, I am flying down to have the surgeon who is going to do my RNY to DS revision order the tests, so that way, everyone will know what the SURGEON is looking for, to prove the "medical necessity" to my insurance company. What a pain in the ass, and, expensive to, just to fly out from Alaska to California is $1,000.00 ---- Not to mention the medical costs on top of the trip to get there!!!!
GOOD LUCK!!!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I talked to one of the very experienced office managers for 1 of the doctors in Georgia today that I am considering. She says it is very important to have everything done right, extremely thorough with all test results and operative notes, all the way back to my 1st lap band in 2004 and all the other tests in between not to mention the 30 trips I have made back and forth trying to find restriction with my band. It doesn't work for me. Too lose or too tight and throwing up!
She told me that ongoing pain and multiple times per day vomiting when tight and still vomiting some now that I am loose is absolutely medically necessary. I have lived with this way too long. I don't know yet if she is right or not but I am prepared to fight them. In all actually I could have already done damage to my esphagus.
I wish you so much luck. I think that some of the best surgeons don't have the best insurance people and vice versa so you really have to push them to get it all together thoroughly when submitting.
My sister is 9 years out from a RNY by the way and has regained 50 lbs. so I don't know what her options are but I know she is discouraged! The DS sounds like a good option to me.
Since I have a band I think I am going to try the sleeve first and hope for the best.
She told me that ongoing pain and multiple times per day vomiting when tight and still vomiting some now that I am loose is absolutely medically necessary. I have lived with this way too long. I don't know yet if she is right or not but I am prepared to fight them. In all actually I could have already done damage to my esphagus.
I wish you so much luck. I think that some of the best surgeons don't have the best insurance people and vice versa so you really have to push them to get it all together thoroughly when submitting.
My sister is 9 years out from a RNY by the way and has regained 50 lbs. so I don't know what her options are but I know she is discouraged! The DS sounds like a good option to me.
Since I have a band I think I am going to try the sleeve first and hope for the best.
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