Ugggghhhhh. Here we go again.

A little history on me: I had my original band placed in 1/09. I had port replaced in 8/09. I had a slipped band with surgical repair in 1/10.  My lowest weight was 212. I have since put on about 30 pounds over the last year or so. I average 1200-1600 calories per day. I work out for 60-90 minutes at a time 3-4x/week.    I am extremely sensitive to fills. I have had numerous fills and unfills and we have done 3 complete unfills in the last 2 1/2 years. I continue to throw up a couple of times per week even though my band is almost empty.   We submitted and got denied for a revision. We appealed it and also got denied.    

Today I had an EGD and it showed that my esophagus is dialated. So basically this means no fills at all for me and I have to rely on just having the band in place. So I am back to only will power.   We want to revise, but without insurance approval that is out of the question. The doctor asked if I was interested in changing jobs, so that I could change insurance. That is also out of the question.     So we are going to try applying a revision again.  

If anybody has any templates or research for lapband revision to RNY I would great appreciate the help.  I don't need to hear about how I should consider the DS instead of the RNY. I have done my research and this is my decision if I ever get approval. 

Steph

Your doctors office should have someone who is knowledgeable with the insurance appeals. My doctors office goes to bat for the patient... I have never had  to talk to insurance.

Why are they  denying you if I may ask? 

Our insurance is a self funded plan so it is a little bit different that your typical insurance plan.   They are denying it on the clause that it is one surgery per lifetime.  I am thinking if I talk to our medical director in person, plus write a letter myself. I know the medical director indirectly. He is a physician at our hospital, plus I am a nurse there.  I am also having my PCP and chiropractor write a letter as well as my surgeon.

If there is serious complications I do not see how they could ever deny it.. I wish you luck but I wouldn't stop appealing.

But you have  MEDICAL problem with your Band. That *should* trump the "one-per-lifetime" clause. If they give yoou any static, get a lawyer.