Insurance denied

I was able to get the band removed as it was a medically necessity complication of the first surgery.  I had four years of documentation of the problems and test - they paid for.  I also was getting a fill or unfill every month as it tighten and loosened.  They had approved me for 24 more visits even.  I included in my personal appeal that they had shown that there was problems if they had approved so many visits for one year and the wording in the contract when I received the band was that complications from surgery were covered.  That wording is still in there.  I would get a copy of how yours is written before appealing.

Like Sherrie I had 9 months of journaled everything I ate and all my exercise.  

Check out the insurance boards on OH.

Well... that once in a lifetime clause is going to be hard to overturn.

Do you have erosion or another dangerous condition? Or does the band just SUCK like mine did?

My insurance denied the first time and the peer to peer review because they could not prove there was a band dysfunction. Finally my personal appeal worked.

Had it not, I was going to Mexico with Ready4aChange and they will do a band to sleeve revision for something like $6800.  They put my band in. It wasn't there fault it sucked ... it was the band.  

Best of luck!!

if you don't mind me asking what did you put in your appeal letter?

I had a very detailed account of all the effort I had put into losing weight with the band.

I showed all of my fills and unfills.

I also included a letter from my nutritionist that said I would be compliant with the RNY lifestyle.

I have a spreadsheet of my weight loss/gain from 2 years before the band until current - that I included.

I included some references about failed lapbands as well.  You can google Failed lapband and get some compelling articles. 

Your biggest obstacle is going to be the 1 surgery clause.  That is how insurances are getting away from revisions.  A lot of money has been spent on revising band patients.

Good luck!

thanks i just want them to remove the band at this point and I'll deal with the revision part later