I need help!!!! So disappointed!

Hello Guys!!!

I need help! let me tell you a brief history about me...

I got a lap band in January 3rd 2011... I am 5'7 at 295 pound the day of surgery.... i lost 45 pound and gain almost everything back.. now I am at 290 (haha not that different) ... I completely hate my lap band... it never worked for me actually.. the pounds I lost it was because I was dieting, I never was in the green zone.. or it was too little or too much! 

Ok.. so February this year I went back to my doctor and told him that I wanted a revision for something else.. and he said it was fine since I was more than 2 years with the band and same weight.. 

So... I started my 6 months follow up with the nutritionist, did everything they told me do to but I was really disappointed with the staff and decided to change doctors... I transfer all my file to this new doctor and continued to do my last month visit, endoscopy and all that...

Yesterday I was at the office and this lady that handles the insurance told me I will need to do 2 surgeries... 1 to take my lap band out.. and another one for the bypass... does this makes any sense at all? because for me it does not! what if I take my band out and they dont approve me for the bypass?

I asked why and she told me that if they send the claim for both surgeries at the same time I will get a denial.... and told me to do 2 surgeries... why is that? if both surgeries are through the same ''holes'' ?? and why is that, if they will have to pay twice of everything to this doctor? I even told her I wanted to send only 1 claim and she told me that if i got a denial she wont be helping me with the appeal......

Ahh this is making me really angry and frustrated!!! I work and I have a 11 month old baby at home and I just cant deal with 2 recoveries... Did anyone had to do that? Can anyone please explain ? I have Oxford Freedom by United Health.. did someone here with the same insurance? 

 

pleaseeeee helppppppp

I don't think it has as much to do with insurance as it does surgeon's preference. Altho some will do it all in one surgery many insist on doing two because of all the scar tissue the band leaves behind. They have to clean all that built up scar tissue out and let that heal before they go ahead with the next surgery. Also have you looked at the sleeve for a revision instead of the bypass. The effects of the bypass and its malabsorbtion wear off after a few years and you are often left with dieting again, altho it is easier once you've lost the weight, Just something else to think about. I think the only way to get it done all in one surgery is to find a surgeon who will do it that way. Good luck to you!

Some surgeons will do it in one surgery, some insist on two, and some take a "wait and see" approach. Sometimes it's just not possible to do the revision until the stomach has had a chance to heal.

And yes, you really need to investigate all your revision options. Besides the RNY/gastric bypass, there's the VSG/Sleeve and the DS/duodenal switch. Both the VSG and the DS reduce the size of the stomach, but preserve the pylorus, the stomach's normal emptying port. This means you don't have to deal with dumping syndrome, getting food 'stuck', or worrying about stretching your stoma. The VSG is a restriction-only surgery, meaning there's no intestinal bypass. The DS has the same stomach plus an intestinal bypass similar to, but more effective than, that of the RNY/gastric bypass. The DS has the very best long-term, maintained weight loss stats, period.

Get a couple of additional opinions before making the final choice 

My surgeon will only perform the revision in a separate surgery.  I had my band removed in May and hope to have RNY in October.  My surgeon admits to being conservative but feels that it's safer to heal completely before revising.  My RNY will be submitted as a completely new WL surgery, not a revision.  He said the likely hood of approval will be better done this way.  HOWEVER, many have the removal and revision done in one surgery.  It's just depends on the surgeon and what your insides look like when the band is removed.  I've read where some go in thinking it will be done all in one surgery only to find that there was too much damage to do both in one surgery.  

It would have been nice to know this up front, but your only option may be to find another surgeon which would be a big pain!

I feel for you, but if it's helpful, the recovery from the removal was a breeze!

Lisa O.

My Lapband eroded, so my situation is a little different, but my surgeon required separate procedures. In hindsight I am very glad. The band did a lot of damage and let things heel for a time made the RNY a safer procedure. Maybe talk to the surgeon about why? The reasons could be more about your long term health than insurance (which was approved in 24 hours in my case). Good luck with your journey...either way, it will be worth it!

 

A revision surgeon, one you should be going to anyway, can do it all in one surgery.

I'd find a new surgeon and you can always appeal on your own if you need to.

I just had my band removed and was sleeved, along with a surprise hernia repair, all in one surgery. It's been only 11 days and I feel great! I understand your frustration. I have bcbs (New York State) and my surgeon, who is very experienced in revisions and told me he handles over 80 band revisions to other surgeries each year said one surgery is perfectly acceptable. I know other surgeons have different feelings about this. When submitted to insurance they only approved for band removal but not the sleeve. I decided to fight them on my own because I thought that I would devote more time and attention to my appeal than a doctors office when they are handling hundreds of patients. After 6 months of three levels of appeals, I won and convinced an external panel of doctors that it made the most sense to do everything in one surgery as opposed to two. Don't give up if you want to get it all done in one surgery! I would suggest that you seek out a second opinion from a surgeon who does a lot of revisions, if your current surgeon does not. I think it's a bit concerning that your current surgeon is telling you that they won't appeal if you don't do it their way. Don't afraid to be your own advocate for your health! I too have young kids and didn't want to deal with two separate surgeries. If you need any guidance about dealing with the insurance company if you want to take then on, feel free to message me. Best of luck to you!!

Hi there!

So sorry that you're going through such a frustrating time in all this! I know nothing about the insurance portion of this, my parents paid cash price for the band. But I'm also moving towards a revision from Lap-Band to RNY. I only lost 20 lbs, almost instantly gained it back and due to constant swelling, acid reflux and a myriad of other problems, all fluid has been removed from my band for almost four years (but, it still causes lots of problems.)

My new surgeon is planning on removing my band and said that if we did revise, it would be in two different surgeries as well. He said that it was to give my insides a chance to heal and to make sure that my stomach was okay on it's own before we went ahead with RNY.

While I'm impatient to get this done and finally lose some weight, I've also heard (on these forums somewhere) that the risk of complications is lower when a revision is done in two separate surgeries and that the body is able to handle it better. So, maybe a way you could look at it is one long, possibly more complicated recovery  vs. two shorter, less intense, maybe less complicated recoveries and knowing your body is ready and healthy on it's own before you have a big, very hard to reverse surgery.

Slow and right beats fast and wrong, right? (I'm sure tons of people have had it all done in one surgery and are doing great, but knowing that I *have* to have it done in two, these thoughts are what keep me optimistic and from getting super stressed out and trying to rush the process. Hopefully it'll be of help to someone else!)

Anyone who is suffering with a Lap-Band gone wrong knows the kind of stress and aggravation with simply trying to get it fixed and it's really hard to find the good in these types of situations, but keep your chin up and get your second opinions, do your research and make the best decision for you. Don't give up!

Best of luck to you! 

 

My surgeon did it all at once. 

I would contact your insurance company yourself and ask about their revision policy. They should be able to answer your questions.

My surgeon did warn me that if he got in there and my stomach was a train wreck he would have to just remove the band and then RNY later.

Your insurance company surely has revision guidelines.  My surgery was coded as lapband removal and RNY.  BCBS has a very well spelled out Revision Weight loss surgery policy.

Best of luck to you.