Revision Denied and Depressed

I got a call yesterday that my insurance company denied my revision surgery because there was no defect in the band.  I don't really care if the band was defective.  My body after 5 years has had enough of throwing up every day.  Some days on a glass of milk or a 1/2 cup of apple sause.  Yes, other days it's chicken or steak; but I should know that when I drink a cup of milk it will stay down.  Apparently that doesn't matter to them.   There will be a peer to peer between my doctor and their doctor, but I am not hopeful.  He's not going to be able to prove there is a defect and that's the way the policy is written. 

So now what do I do?  I tried everything or I wouldn't have this blasted band in me already.  I can't imagine being like this forever, but I don't feel like there is much left to do.  In the past year, the weight has started to affect me more and more.  More joint pain and less mobility.  I have coached my daughters sports teams, but now it leaves me exhausted and with a great deal of pain in my joints.  At 45, it has really caught up with me.  That dang goal list i made on my profile is haunting me.  Now it's a list of fantasy ideas that will never be.  Feel like I lost more than just feeling better.  I feel like I lost part of my life.  (I guess I already gave it away as I became this heavy.  So maybe it's not mine to have.)

Any advice?  Feel like no one in my life really understands, even thought they try and remind me how much I am loved.  

Ugh! This is my worst fear! I can only imagine how you feel. I am waiting for my insurance answer now. I was banded 3 and a half years ago and been a sliming, stuck mess the entire time!

I had all of the fluid removed from my band which has helped with the stuck and PB'ing.  I still have horrible heartburn in the morning.

 I just wanted to tell you, I feel you! I can relate (ish). I know what it feels like to fail and be in pain and know that there's a solution but not being able to do it.

I wish you all of the luck in the world! I hope we both get to our ultimate goals of health! Fingers crossed for that doctor/doctor meeting!

I was banded in 2006 and am scheduled for revision to RNY in August.  It might help your case for revision if you ask your GP to order a endoscopic test to check for Band erosion and ulcers.  The heart burn you are feeling in the morning upon waking is often a sign that we don't take as seriously as we should.  I had that for several months and in the end it has done real damage.  

I am fortunate to live in Belgium and my surgeon routinely removes Bands and performs all types of revisions.  All revisions are covered by the health care system without argument.  Maybe with proof of harm, the insurance company will support your need for Band removal.  

Good Luck!

Has you doctor done tests to make sure you band is not slipped?

No.  No one has ever done any tests to see why I throw up.  My old surgeon says its just normal for some people.   My current surgeon said it's because I have reflux and always have.  

Did the reflux stop and then return after banding? If you had a HH (which many MO have) then it should have been repaired during your surgery. For it to later return after banding is not uncommon. We seem to see a lot of bandsters with HH, even those that have lost weight, so I think that the lapband can cause this to occur.

Anyway.........I have a file that has info on insurance appeal for revision. Join and check it out.

Good luck!

This happens very often with the band and it IS  cause for removal. You need to have a manometry test to see if you are swallowing right. You need to find a doc that will help you file an appeal and deal with your issues. These are very common issues for revision but you need a doctor willing to help you. If you are vomitting that is NOT normal with a correctly adjusted band.

ok so unless i misunderstand your dr submitted a request for a revision with no medical necessity to remove the band? why would they approve that?  proving band malfunction is very difficult.  so it is never normal to be vomiting-ever, whoever told you that is a moron.  you need to have test to see if there is any complications caused by the band deeming your explant and potential revision medically necessary.  from you what you said that vomiting will probably get worse, get yourself tested before you have irreversible damage, like me...good luck to you....

Like airbender says you have to prove medical necessity.  I had to have proof that I had been filled and unfilled, totally unfilled and scoped that caused medical issues from the first year on.  I had been to the docs to be filled or unfilled at least once a moth for the last 9 months.

I had a verbal appeal with the head of customer service and head of reveals.  They talked to the head medical of review after talking to the center to verify all the medical issues.  They verbally approved but only approved the band removal on paper.  After the band was removed, I had to go thru all the steps to get approval like I was a first WLS.

It helped when the band was removed, there was medical evidence of the problems it caused.

Testing and doucumentation is the key.

Appeal!