Help! Ins Co denied for final time. What is considered a technical failure

I have had a lapband in since 2003. Had it filled and unfilled for the first 3-4 years. Either went from no restriction to throwing up everything. Went through IVF 6 times and IVF doctor did not want band to have anything in it so... Never really lost weight but didnt want to be cut open so I left it in unfillled. 2 or 3 years ago I started having intermittent stomach/band pain then port pain. EGD and Barium swallow showed nothing abnormal. It feels like the band or port is pulling on the muscles around it when it hurts. Dont know if anyone else has had this problem. Long story short, I want it gone. I have a BMI of 35 with multiple co-morbidities. Insurance denied the band removal and conversion to sleeve because they are saying the problems arent due to a "technical failure" no erosion, no slippage. Has anyone else been denied for something like this and what did you do? I cant really find a good internet definition of all the things that count as a technical failure. I consider 2 years of pain and thousands of dollars already spent to be a technical failure. Im having to take pain meds to deal with this when it hurts. Anyone got ideas?

I completely understand your struggle right now. I have the same complaints and have started the appeals process. I have always had port pain that has gotten worse over time. My doctor has been unable to come up with a reason for it. I think he ultimately decided that I was making it up. I was denied based on medical necessity, not sure if by definition they are the same or how it would differ from a technical failure. I ended up hiring someone to help me with my appeal and I am waiting for approval. Have you completely exhausted the appeals process?

Im so sorry to hear you are going through the same ordeal. The insurance coordinator in my doctors office sent in a formal written appeal after the first denial. The problem with that is that by doing that she waived my right to a peer to peer review. The peer to peer review should have been done first. Now Cigna wont even speak to the doctor or his office and they are saying that there is nothing I can do now. Cant even resubmit through a different doctor. Out of curiosity, is it expensive to hire someone for an appeal?

I'm sorry to hear your doctor is writing you off.  Your situation is becoming common.  They write us of as nuts but, when he got in there he found problems that justified the removal and I was able to win an appeal with the medical proof of problems.

Check out the failed band group.

I'm going through the appeals process right now as well. I got my band in 2004, it was removed in June 2013.  I just submitted my letter on Thursday. I wrote it myself and I am so nervous! My sleeve surgery is scheduled Jan 6.