I was denied for a revision surgery.

I called my surgeon's office to check the status of my case and she said that the insurance denied me because I was non compliant with my previous surgery (lap band). She said that I can call the insurance company and appeal. What can I tell them to make them change their mind?

The reason I was non compliant is because I was very depressed at the time. I'm hypothyroid and if i'm not on the right dose it makes me feel depressed, nervous and anxious. I have been seeing a Endocrinologist to get me at the right dose.

Please help!

Well the band not working is very common! So you aren't alone on that one. However I wouldn't admit to the insurance co. that you were non compliant for any reason unless you doc has already told them that. Unfortunately you not being compliant is not a valid reason for them to revise you. You may have to be compliant and get fills and actually try to work the band, not that it will work because like I said they really don't work very well unless you are a volume eater. I would contact the insurance and ask them what they need to show compliance? Then do what they say and have either your surgeon or primary doc monitor you monthly to prove you are being compliant also journal your foods, then maybe down the road they will approve the revision but I think they will make you prove that you at least tried to work the band. Your depression isn't a failure of the band and is kind of irrelevant in the way the insurance companies work. You may not get a revision right away but you can at least lay the ground work for one in the future. Now if the band is causing pain or vomiting that's a whole different story. Good luck, don't give up tho, never give up!

 

I'm going to see if I can get a fill and make it work. I asked the insurance co. if they would cover the removal of the band and she said if I was having complications they would. But like I said I will try to make this band work and if it doesn't then I'm screwed!

Have you been on the failed bands message board?  You might want to check there as well.  What revision surgery were you interested in?

 

You HAVE TO Fight for what YOU WANT!!!!!  Do not give UP!!!!!!

 

RNY

I think, if you were having depression issues that caused you to be non-compliant until your dosage was corrected, you need to demonstrate compliance now that it has been adjusted.

If you are lucky, your band will work with compliance and you will avoid to avoid another surgery.  If your band doesn't help or causes a recognized medical issue that necessitates removal, then push the issue of revision once you have demonstrated compliance.

Maybe change insurance companies (if you can).  What evidence do they have that you have been non-compliant?

 

I told the nutritionist that I would throw up a lot and I guess she took it that I was over eating and wrote that down on her notes. Either the band was too tight or loose. I could never find my green zone.

First thing I'd do is insist the nut change what she wrote. If you were throwing up you were too tight! You shouldn't throw up with a properly adjusted band, at least not on a regular basis, once in awhile foods will not sit well and you may vomit, but that should be very rarely. The fact that you could not get in the green zone IS a reason to revise, that happens to thousands of us!!!! I was that way too and my surgeon said that is the biggest reason for revision because nearly 1/4 of all the people with bands have this issue and it really can't be fixed because the body just doesn't like the band there! You are getting very poor service from your doc, I would think about finding a new one that is going to be an advocate for you instead of setting you up as a failure! Good luck hun and come over to the regular lap band forum you'll get lots of help over there about how to work your band or see about a revision.

If you are throwing up that is an issue.  I don't know how your center is but, with mine I told the nurse/PA and who every wrote anything about me that food was getting stuck no matter how small a piece and how much I chewed food would get stuck and/or I'd throw up.  I went in to see them for fills and unfills 8 out of 12 months.  In hindsight I would have gone in every month.  I also journaled all my food on a food logging site and showed I was meeting all my protein and water and was still gaining.

Go to the failed band group and join.  There is so much great info over there.  It will help you determine if, in fact you were compliant and what you need to do to determine if the band has failed you and how to prove it.  To appeal you need to prove that what they are saying is otherwise.  In you case the Nut needs to be talked to about her misunderstanding you and changing what she wrote.

My PCP had written what I told her but added she believed I was just eating to much.  Every thing I told the nurse/PA and the journal proved she was wrong and I am now approved by the insurance co.

http://www.obesityhelp.com/group/failed_lap_bands/