Oh, I understand now. Thanks!

Do your research on converting from a lap band to a sleeve. That is exactly what I did originally. I was told today by a very knowledgeable person that studies are showing now, if you had problems throwing up with the band, you will probably have the same problem with the sleeve. Again, do your own research and make an informed decision. Good luck

Are you stating Traditional Medicare would not cover the conversion to an RNY because I had the original weight loss surgery (gastric sleeve) in Mexico? Also, it sounds like you have a Medicare Advantage plan if your coverage is through UHC, correct? Sorry, but I'm just a bit confused.

Thank you for your response.

I am converting from sleeve to RNY.

Sleeve was paid by private insurance.

Medicare will not pay for revision if they did the primary surgery.I am approved by Medicare A and B. I have United Health

Care plan F. They have paid for everything at this point.

My best to you.

I wanted to make you aware of what I'm experiencing now. It may or may not help you in your decision. I had the Gastric Sleeve in Mexico over 12 years ago. My experience was wonderful, lost over 100 lbs and I've kept it off. Approximately, 2 years ago, I started throwing up undigested food, every time I eat.(A lot like the way you describe your band experience).

My doctor in the states found that I had a large para esophageal hernia and they were able to repair it and it was suppose to take care of my problem. My surgeon said my sleeve looked fine. It was a little larger than they make them now, but consistent to how large they were left 10-12 years ago.

The reflux did not go away and therefore my doctor thinks I need to be converted to a RNY. Now, I have a huge problem. When my surgeon sent in the prior authorization for the conversion, it sent off red flags. My insurance is starting to recoup monies paid because they say it's due to complications to my weight loss surgery. My insurance covers weight loss surgery, but you have to follow their guidelines to get it paid. They are telling me that because I did not go through getting it approved with the insurance carrier that I had at the time of surgery, (which was not BCBS, but they were just as strict about weight loss surgery, thus why I went to Mexico) they will not cover any of the procedures that I have had done due to complications, nor will they cover the RNY.

I will be eligible for Medicare in December and at that time I plan to have the procedure. I know that there are US doctors that include complication insurance in their cost. I strongly recommend you check into that. Right now, I'm looking at approximately $150-$200,000 out of pocket for procedures and testing I have had done. I am hiring an attorney to fight BCBS, but I don't know how that will go.

I also want to tell you that even though, I'm going through all of this grief and I don't have the $150-200,000 that I will be responsible for, I don't regret my sleeve. I think it saved my life. I had a stroke in 2015 and if I had still had that extra 100 lbs on me, I probably would not be alive or I would have had serious complications. As it is, I'm very fortunate that I did not have lasting side effects from the stroke. I am on blood thinners for the rest of my life, but I am alive and I think the sleeve is the reason I am. Just my thoughts.

I am not trying to scare you, but wanted you to know all the possibilities up front.

Good luck!