Revision with Medicaid and frustrations

I have heard several times that Medicaid will pay for a revision but every doc I speak to says no! I have a realize band that was placed in 2008, I recieved 2 fills this entire time. I had some restriction at first but haven't seen any since the fall of 2008, (surgeon refused to give me any more fills after I lost 30 pounds). My surgeon moved and the hospital I had my surgery at closed down their bariatric center. I have had constant pressure around the port and discomfort from the band. I I went without a fill and band care this whole time because no one would see me without insurance (due to being laid off), I now have medicaid due to some other medical complications. I have had to have most of my molars removed and can no longer chew through any meat well enough to get it through the band (but I can chew it up to the size of a pea) even though I don't have restriction enough to limit my food intake. I had a baby 7 months ago and during the pregnancy I had decent restriction and only gained 12 pounds. I am now back to my pre-surgery weight! The hospital that orginally did my surgery has reopened their bariatric center but will not see me until September!!!! I want the band out now but also want help with my weight! Will a revision work for me due to my chewing issues? If so will medicaid in fact pay for it?  If so how do I go about it?

What state are you? Have you called and asked them? What did they say?

 I'm in NC. Medicaid said they will pay for 1 weightloss surgery if I meet the guidelines. I paid for my first one with my insurance and company's by my previous job. They will not give me an answer for revisions but say to discuss it with my surgeon. My Bmi is 42 and I have a ton of complications with/from the band that I've had the entire time. 

I don't know if this will help but maybe:

I used to have a link for Medicaid rules for all 50 states but I have lost it somehow. But I would guess that if Medicaid did not pay for your first one then they should pay for your next one. It is possible that they do not distinqu**** as a revison but as a seperate surgery. Medicare does not seperate the surgerys it is just a surgery. Like an RNY revison is treated just as an RNY so it is covered. I do not know if Medicaid is like that in your state but it would be a good idea to first call the surgeons office and ask them When you call the surgeon don't ask the girl at the front desk. Ask the Insurance specialist.
 and then call Medicaid and ask them. Maybe if Mediaid payed for the band removal and then do an RNY it might be considered New.  I was so unsure if the person at Medicaid new the right answer or not I called in 4 times to see if I would get the same answer.

Go to Forums, Go Local, More, and look for NC they have a list of Medicaid Surgeons. These will know if Medicaid will cover Revisons. I called One for my state and the Co-ordinator knew the answers about Medicaid coverage I needed. I will try to find that link for you. Good Luck

Post again with the heading of "Medicaid in NC" in the Main Forum and then "x-post" the same in the Revision Forum. You may get more of a response

 Thank you! I will def try that! Do they take out the band and do rny in the same surgery usually? Do you have to chew really well with rny? 

I don't know about the surgery part I guess it depends on what Medicaid will do. Yes you have to chew really really well in the begining stages. If you cannot then you will have to either puree your foods to a chewable size or have Alicia Silverstone pre chew for you.LOL

As you get farther down the road you will not have to chew as tiny but still you will have to chew. I only have front teeth so I have to chew with my front ones only. It is hard and I have just given up eating any steaks, roast, chops. I eat fish, fowl and ground up beef or pork.

If you don't have a medical reason you will have to "self-pay".  Why don't you get Band care first and try working with your band before thinking about a revision?  And maybe get some dentures while you do have medicaid so that you can chew - you'll need to be able to chew even without WLS.  Using your front teeth to chew can cause more damage.

No one I know on this board has gotten their band removed just because they wanted it removed.  Your port discomfort could be due to a shift during your pregnancy BUT it could be something else.  You will never know until you take an active stance in your medical care.

Best,
Leila

If you are in NC try Dr. Ng @ Rex Surgical Specialist . They are excellent and the cordinator Krista is very knowledgebale and will give you great advice on how to get your revision process started.