Banded, having issues and want a revision surgery approved by insurance, lost 150+
Hi there,
I have a very VERY long story, but will keep it brief. I was banded in 2010/2011 (honestly cannot even remember) and the band did not work well for me. I was basically "stuck" 24/7 and vomited while eating per the guidelines, which left me malnourished and sick for about 5 years until I learned to get food past my band. My health improved, but the vomiting still occurred periodically. It was then that I started losing weight. I went from 320 to 185 and plateaued there (plus or minus 10-20 lbs****il I found Keto this year and dropped to 165 today actually. :)
The vomiting is now way worse but in waves...nearly every meal, more often than not...and I have been experiencing sharp pains in my port area and central stomach that seems to get worse and more frequent over time (last 6 months or so).
I am in the process of reaching out to a local surgeon for care and revision. I had Cigna when the band was installed and have Cigna once again now. The band was initially approved, first try, after completing the 6 months and exams and so on...
I am not a "healthy weight" for my height (5'5, just under 170). based on that I would not qualify for a NEW surgery if I were to apply. Obviously I do not want to re-gain the weight I FINALLY lost after a DECADE of hard work. Removing the band might cause significant regain, so I want a revision.
Here is my question: When applying for a revision from Lap Band to another type (sleeve, RNY, etc.) will I have to have regained or will I possibly be denied because I am at an acceptable weight? Do they even consider the impacts of regain?
Also any surgeon recommendations are welcome. I reached out to Surgical Healing Arts of Ft. Meyers bc they seem to do a lot of revisions.
Thanks in advance!
-Amanda, 32, Tampa
Your situation sounds completely miserable and I hope you can get whatever it is that you need.
I've got no surgeon recommendations but I do know that all of your questions about what your insurance covers can only be answered by speaking directly with a representative there. Call the 800 number on the back of your card and get detailed responses. If they will approve a revision pending different things print out a dated hard copy of their response and a dated copy of your policy as it stands today.
It sounds like a bit of a pain in the ass, but insurance companies make changes to coverage all the time. Employers change the policies they offer to their employees just as often. Having a dated hard copy ensures that you'll not jump through all the hoops only to have your coverage changed in the meantime.
Good luck. Revision coverage is so hit and miss that there simply isn't one blanket answer.
Thank you, Amy. That's a good point I had not considered - calling my provider and just asking! Funny how something simple slips the mind! The good thing is my employer is very large and values weight management very highly. I don't foresee them cutting the coverage, but I'm certainly not going to wit around. This band is killing me and MUST come out! Fingers crossed I don't have to pay for the entire surgery out of pocket
I'm glad you had good doctors who fought for you. So sorry it did not pan out to be covered. :(
It seems so unfair to not cover the next step in ensuring your progress is not lost. I really despise the current state of insurance as it pertains to bariatrics. Our co-morbidities are still very real risks that we must manage. After years of having "help" they just abandon us? It's really a miss in my opinion. sigh....
Unfortunately, you may end up having to self-pay for revision surgery as insurance may not cover it, which sucks. If that turns out to be the case then you may want to consider gastric bypass surgery in Mexico. Many OHers have had great results with band-to-RNY surgery at Mexicali Bariatric Center.
Thank you. If a revision is not covered, I think I'll try to manage my weight with Keto first. I am not the same person I was when I got banded and have much better habits. Maybe that's enough? If not, Mexico is a cost-effective option, I just don't think it's the direction I want to take initially. :)
I have United Healthcare and the funny thing I just learned is If I choose to take out the band, I am covered 80% and I pay the rest...If I choose a revision... its 100% I have had the band since 2011 and I am almost back at my starting weight. The Dr office called me to inform me that the bands are causing damage to the esophagus and they asked me to come in to check it. I had the GI done and will follow up on Aug 30th to discuss my options. But really my insurance made the decision for me and I am okay with that process.
Wow, so your doctor actually was proactive in informing you there are issues!? That's awesome! It's exciting news for those fighting doctors to even consider there are issues caused by the band. Maybe they are all starting to catch on that the band was not a very smart invention after all. :)
Also, UHC is super solid for covering the revision 100% and it honestly gives me some hope with Cigna. Have you lost significant weight or was the band unsuccessful for you? I don't know if the amount of weight lost is or is not a factor, but I am hoping my long term health and success is the priority here. I worked damn hard to get here and don't want to balloon as soon as this thing comes out. :/ SO stressed!
Oh yeah I told him I had not been back to his office for years because I was embarrassed because of the regain and he said the band is good for a few years and that's it . He said he wont even offer them to his patients anymore and he has done sooo many revisions.And now with esophagus issues, he is being proacive and calling everyone to get checked. I lost 58 pounds total with it but regained about 35 back. So I just felt like oh well this is it ,I am getting heavy again ,and out of the blue his office called me now I feel like I have a second chance.My first surgery was with Cigna and I remember having great coverage with them but I switched because my company offered UHC a little cheaper than the Cigna one.
Dont be stressed , just reach out to Cigna and let them know that you have heard of problems and what would they cover if you do a revision.Hopefully if you mention the fact that its causing problems, maybe a revision will be covered. I remember asking Cigna in 2010 that if I opt to remove it what would happen and they said I would pay BUT if it caused health problems they would cover it. Keep me posted, I am thinking about ya!!!
