What is considered a medical necessity?
I hate to break it to you, a sore port and poor weight loss do NOT constitute a medical necessity.
Not losing weight is generally NOT considered a criteria for revision. If the band is not a mechanical failure or has eroded or slipped, you might be out of luck.
I know with my insurance, they specifically said that a revision would not be covered soley because I wasn't losing weight. As far as they are concerned, that's your issue, not theirs. Further, they said if I was unable to lose weight (i.e. follow the plan) with the band, who's to say I would be compliant with a revision. My surgeon agreed.
I am not trying to sound mean, and I hope you don't take it that way; it's just from what you said there is no reason they would cover a revision.
My band was causing severe reflux and vomiting, even while empty. That was a medical necessity because I was not able to eat. ETA - I had my band for only 8 months and my reflux got progressively worse each month. I was banded in June 08 and it was removed in March 09.
Have you had any testing to see if your band is still in place or has slipped since you say you don't have restriction? How big is your band and how much fluid is in there?
What do you eat?
Why don't you call and find out revision criteria?
Not losing weight is generally NOT considered a criteria for revision. If the band is not a mechanical failure or has eroded or slipped, you might be out of luck.
I know with my insurance, they specifically said that a revision would not be covered soley because I wasn't losing weight. As far as they are concerned, that's your issue, not theirs. Further, they said if I was unable to lose weight (i.e. follow the plan) with the band, who's to say I would be compliant with a revision. My surgeon agreed.
I am not trying to sound mean, and I hope you don't take it that way; it's just from what you said there is no reason they would cover a revision.
My band was causing severe reflux and vomiting, even while empty. That was a medical necessity because I was not able to eat. ETA - I had my band for only 8 months and my reflux got progressively worse each month. I was banded in June 08 and it was removed in March 09.
Have you had any testing to see if your band is still in place or has slipped since you say you don't have restriction? How big is your band and how much fluid is in there?
What do you eat?
Why don't you call and find out revision criteria?
Hey
I think I ask you in your other post if you spoke to the Dr about your thoughts of revising. How often did you go to the Dr for fills? Have you been compliant with all the rules given to you when you had the lapband placed? Have you started the vomiting and acid reflux yet with the band? I ask all of these questions because these are signs that the band is starting to act up. In the long run the band will lead you to all of these problems but im not sure if your actually there yet. The fact that your band is still kinda new you may not have develop all of those problems yet. Its probably best to start with an upper GI to see how the band is holding up. Make sure you dont have any slips or any problems that you may not know of. I will tell you that the longer that band stays in the more problems you will eventually develop over time. Its just a matter of time before it start to fail you.
I think I ask you in your other post if you spoke to the Dr about your thoughts of revising. How often did you go to the Dr for fills? Have you been compliant with all the rules given to you when you had the lapband placed? Have you started the vomiting and acid reflux yet with the band? I ask all of these questions because these are signs that the band is starting to act up. In the long run the band will lead you to all of these problems but im not sure if your actually there yet. The fact that your band is still kinda new you may not have develop all of those problems yet. Its probably best to start with an upper GI to see how the band is holding up. Make sure you dont have any slips or any problems that you may not know of. I will tell you that the longer that band stays in the more problems you will eventually develop over time. Its just a matter of time before it start to fail you.
Yes, you are correct!
Although, I hate to say, I do know a few folks who have the band, and it is working correctly, but they either lost the weight and gained it back, or just never lost the weight. They have no complications other than not losing weight, which is a really crappy place to be....no mechanical failure = no revision. I guess I was *lucky* to have the complications I had.
Before the vomiting, sliming and being stuck all the time, I didn't eat much, but everything I did eat just sat there and made me feel lousy. So as every person who's been banded can probably attest to, I just ate slider foods so at least I was eating, but I wasn't eating the right stuff, hence the no weight loss.
These people are not mentioned nearly as much as they should be, because often the band just doesn't' work. And it doesn't make any complications either. So they are stuck with this device implanted inside them and unless they self pay or really work that band, there's not a whole lot that can be done.
I wish that the band wasn't even offered as an option. I know one person who lost about 75ish pounds and she looks great, but she was part of a low BMI study. Her BMI was between 30 - 35 and qualified to be part of the study. I know one other person who has lost more than 200 pounds with the band, and he is an anomaly; I don't know how he did it, but he's kept it off for some time too!
For the rest of us, it just doesn't work or causes issues and still doesn't work. Especially if, like me, you have dieted your entire life.
I hope you are able to sort things out!
Although, I hate to say, I do know a few folks who have the band, and it is working correctly, but they either lost the weight and gained it back, or just never lost the weight. They have no complications other than not losing weight, which is a really crappy place to be....no mechanical failure = no revision. I guess I was *lucky* to have the complications I had.
Before the vomiting, sliming and being stuck all the time, I didn't eat much, but everything I did eat just sat there and made me feel lousy. So as every person who's been banded can probably attest to, I just ate slider foods so at least I was eating, but I wasn't eating the right stuff, hence the no weight loss.
These people are not mentioned nearly as much as they should be, because often the band just doesn't' work. And it doesn't make any complications either. So they are stuck with this device implanted inside them and unless they self pay or really work that band, there's not a whole lot that can be done.
I wish that the band wasn't even offered as an option. I know one person who lost about 75ish pounds and she looks great, but she was part of a low BMI study. Her BMI was between 30 - 35 and qualified to be part of the study. I know one other person who has lost more than 200 pounds with the band, and he is an anomaly; I don't know how he did it, but he's kept it off for some time too!
For the rest of us, it just doesn't work or causes issues and still doesn't work. Especially if, like me, you have dieted your entire life.
I hope you are able to sort things out!
I agree with you a 100%. Most of the people who have the band and lost a lot of weight most likely worked extremely hard to get the weight off. It all depends on what kind of person you are before Lapband. Anyone with a high BMI should never qualify for Lapband. If you have a very high BMI like I did then 9x out of 10x you will not put in the sever work you have to put in to loose weight. I had a friend who lost over 100 pds with the lapband and gained it all back. She was in the gym 7 days a week and was on a strict diet as well. As soon as her band slip she started giving her problems and she was unable to get fills. Once that happen the weight crept back on. I was also was told its not a necessity and my insurance deny me but i fought all the way to the end until they approved. I developed Reflux and GERD which I did i test negative for before surgery. By the time I appeal my case they had no choice but to approve. I dont understand why you have to wait for the band to slip or something bad to happen to have the crap removed. So much cases prove that the lapband is crap and yet they dont remove it off the market.
Totally agree with you as well! Fills were such a pain (even though I only had two) and I can still feel that creepy port and the feeling when the fluid went into the band ::::shivers and shudders:::::
You have to work even harder than you did BEFORE the band for it to work. If you could lose weight by dieting and exercise alone, none of us would be here on this website, would we?
I personally think that the band should be excluded from any WLS coverage, and in addition, I think WLS should cover a revision from the band, even if the only reason it's being revised is for poor weight loss.
That being said, I do think a major psychological evaluation should be in order for that to be covered, to ensure that the patient really is compliant and understands what it takes to be successful with WLS. Because as many have said, "the surgery fixes your stomach but not your head".
Your head needs to be on board for ANY WLS to be successful. Even with something like RNY & DS, where, lets face it, the weight pretty much just falls off the first 12 - 18 months. Maintenance is what is the hard part. I am 2.5 years out, and have been maintaining for a year and a half. It's not easy, but I work at it and keep the weight off. You have to be in this mind and body. It's a group effort :)
You have to work even harder than you did BEFORE the band for it to work. If you could lose weight by dieting and exercise alone, none of us would be here on this website, would we?
I personally think that the band should be excluded from any WLS coverage, and in addition, I think WLS should cover a revision from the band, even if the only reason it's being revised is for poor weight loss.
That being said, I do think a major psychological evaluation should be in order for that to be covered, to ensure that the patient really is compliant and understands what it takes to be successful with WLS. Because as many have said, "the surgery fixes your stomach but not your head".
Your head needs to be on board for ANY WLS to be successful. Even with something like RNY & DS, where, lets face it, the weight pretty much just falls off the first 12 - 18 months. Maintenance is what is the hard part. I am 2.5 years out, and have been maintaining for a year and a half. It's not easy, but I work at it and keep the weight off. You have to be in this mind and body. It's a group effort :)
Most Active
Recent Topics
