Removal of eroded lap band and revision to sleeve?
Hi all. I am waiting to be scheduled for an appointment with a surgeon but, of course, have a million questions going through my mind. I was banded in 2008. I lost 50 lbs, but have gained it back over the past few years. I have been having a lot of stomach pain the past few months and endoscopy last week showed that my lap band has migrated and is eroding into my stomach. It's not even remotely where it started. Really weird.
I am hoping to have revision to a sleeve. I am concerned about cost, as my insurance specifically excludes WLS and "reversal" of WLS, although the removal seems like a medical necessity at this point. Anyway, two questions: Has anyone been able to get the removal part of the surgery covered even when their insurance excludes it? And, second, has anyone had a revision with a severely eroded lap band removal?
My insurance was a Once in life time for WLS. They had no problem doing the band removal though. You may have to fight to get them to pay for the removal but as it has a eroded you have to get it removed asap or risk death. It is medical necessity and not a "reversal" So you should win in the long run. As for getting revise, I don't believe based on the wording you will get revision. Surgeon don't or should do a revision with a severely eroded band. I did see one but, they inserted a pick line at the same time. Depending on the damage and location, I have seen them revise to a rny at the same time. I have seen them do non-eroded band to sleeve at the same time.
I didn't have an eroded band and still am glad they didn't do it at the same time. They fixed some of the damage when the band is removed. But, it still took them 45 minutes to fix damage 4.5 months later when sleeved. The risk of strictures and leaks is much lower with the wait in between.
Oh trust me they can and will refuse to cover removal even if it is a medical necessity. If the policy states it is an exclusion they don't have to cover it. I had mine removed in Feb because of the pain it was causing but the insurance still hasn't paid the hospital and they refused the surgeon and anesthesiologist. There is nothing to appeal because it states no bariatric surgey or complications from it. So I will be paying big bucks when they finally send me a bill.