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    lgmariposa22
    Ponte Vedra Beach, FL
    (10/21/08)
    Member Since: 02/15/10
    [Latest Posts]
    Post Date: 4/19/10 2:02 pm
    Hello. I am coming to this site to seek help.

    I keep a full blog over at lapbandtalk about the horrors I've been through with my band (which I blame mostly on my surgeon, not my band). It just simply wasn't for me, and if it had been taken out a year ago when I requested it, it would've been acceptable. Instead I have spent the last two years of my life unable to sleep, workout, lay on my stomach, or eat anything that may cause gas because the pain is so extreme (and they can't tell me what it is. They don't think it's the band but it started the second I woke up from surgery).
    I've been to the ER 6 times, 3 CTSCANS, 8 different prescriptions, dropped several classes in school because of inability to attend, colonoscopy, upper GI...the list is EXTENSIVE. I had a surgery last month to go in and "look" at things and told him if that didn't work then I was DONE. They found nothing, but removed  a little scar tissue and hoped that was the problem. I was furious when I woke up.

    Also... I have been successful with weightloss. Although I've recently had my band unfilled (for a third time) to see if that would help the unexplained pain, so I am plateauing, but have lost over 70 pounds and I'm only 30 from goal. I am satisfied to maintain without the fill.


    LONG STORY SHORT my insurance refuses to pay for removal, even though I clearly suffer from undiagnosed pain from this band.

    I am here to see if anyone else has been through this? They are saying it is bariatric surgery, which I no longer have coverage over (they used to have it and my original surgery was covered).

    If it's medically neccesary, should it be covered?

    I am so miserable. I feel like this experience has robbed my youth and my emotional stability (dramatic, I know...)

    Is anyone else going through this? They want $12,000 for the removal! I don't want to give me surgeon a PENNY and would rather go ANYWHERE else.

    I tried to call my insurance and asked them What differentiates Bariatric Surgery from Medically Neccesary surgery? And they told me "We can't find any definitive answers for you."

    I feel like I am living a night mare, anyone else out there in this boat?
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    Nic M
    Member Since: 04/14/07
    [Latest Posts]
    Post Date: 4/19/10 4:19 pm
    I went through absolute hell with my band... the pain was severe and chronic. After 2 years, it was removed during emergency surgery. My insurance covered it because I had found a surgeon who insisted that it was a life saving measure.

    You need to have the band removed and soon. I had mine out in 2005 and I still have lingering pain from damage to my diaphragm. It's not something you want to ignore. The pain is telling you that something is dangerously wrong, no matter what the professionals say.

    I feel for you very much. Our situations are very similar. I CAN tell you that losing the band was the beginning of my life. I spent 2 years feeling like death and it was simply like a rebirth the day after I got it removed.

    Let me know if I can help you in any way.
    Nicci


    "The intimate rapport with nature is one of the most precious things in life. Nature is indeed very close to us; sometimes closer than hands and feet, of which in truth she is but the extension. The emotional appeal of nature is tremendous, sometimes almost more than one can bear."

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    lgmariposa22
    Ponte Vedra Beach, FL
    (10/21/08)
    Member Since: 02/15/10
    [Latest Posts]
    Post Date: 4/20/10 9:32 am
    Thank you all  :) And thank you Nicci. It felt so good to start finding people who are in the same boat as me. Just the short time you took to write this message honestly changed me and gave me a lot more hope. Thank you very much.
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    Nic M
    Member Since: 04/14/07
    [Latest Posts]
    Post Date: 4/20/10 9:43 am
    It's something that I've heard over and over since 2003. I don't know why the band is still promoted to the degree that it is, honestly.  I guess because it's still a money-making operation. Your situation is not uncommon. If you go back through the history of the lapband board, you'll see the same thread titles, ad nauseam... questions about pain, slips, erosion, complications.  It would seem to me that the makers of the band could possibly alert potential patients to the very real possibility that they will have chronic pain with the band.

    The way I see it, our stomachs are made of delicate, living tissue. To have an object constricting that tissue for an extended period is bound to cause irritation, at the very least. And some people have systems that are just more prone to reacting to that irritation.  Unfortunately, you don't know if you're one of those people until after the band surgery. In hindsight, I did have a few clues that maybe I wasn't the best lapbanding candidate, however. People with constipation or IBS probably should opt for a different procedure. I found that those problems got exponentially worse after banding.

    I really hope that you'll find a resolution to what you're going through. I've been thinking of you and hoping that something can be done... and done soon... so you can avoid further complications.

    Nicci



    "The intimate rapport with nature is one of the most precious things in life. Nature is indeed very close to us; sometimes closer than hands and feet, of which in truth she is but the extension. The emotional appeal of nature is tremendous, sometimes almost more than one can bear."

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    larra
    bay area, CA
    Member Since: 01/07/05
    [Latest Posts]
    Post Date: 4/20/10 8:02 am
    I'm so sorry you have been through all this!
        Clearly, simply asking for the band removal over and over will continue to get you nowhere with your insurer. It's time to file a grievance, documenting your history of pain from the band, your successful weight loss and that this is NOT bariatric surgery, but medically necessary to treat a medical problem. Every insurer has an internal appeals mechanism per Federal law.
        Hopefully, this will get someone's attention and let them know that you are not going to go away. If you get a final denial, your state probably has an external appeals mechanism you can use, but you need to exhaust your internal appeals first.
        And it would be very helpful if you can get your surgeon to write a letter of medical necessity to support your case. And if he won't, it's time to find one who will.

    Larra
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    deactivated member
    Post Date: 4/20/10 8:39 am
    On April 19, 2010 at 2:02 PM Pacific Time, lgmariposa22 wrote:
    Hello. I am coming to this site to seek help.

    I keep a full blog over at lapbandtalk about the horrors I've been through with my band (which I blame mostly on my surgeon, not my band). It just simply wasn't for me, and if it had been taken out a year ago when I requested it, it would've been acceptable. Instead I have spent the last two years of my life unable to sleep, workout, lay on my stomach, or eat anything that may cause gas because the pain is so extreme (and they can't tell me what it is. They don't think it's the band but it started the second I woke up from surgery).
    I've been to the ER 6 times, 3 CTSCANS, 8 different prescriptions, dropped several classes in school because of inability to attend, colonoscopy, upper GI...the list is EXTENSIVE. I had a surgery last month to go in and "look" at things and told him if that didn't work then I was DONE. They found nothing, but removed  a little scar tissue and hoped that was the problem. I was furious when I woke up.

    Also... I have been successful with weightloss. Although I've recently had my band unfilled (for a third time) to see if that would help the unexplained pain, so I am plateauing, but have lost over 70 pounds and I'm only 30 from goal. I am satisfied to maintain without the fill.


    LONG STORY SHORT my insurance refuses to pay for removal, even though I clearly suffer from undiagnosed pain from this band.

    I am here to see if anyone else has been through this? They are saying it is bariatric surgery, which I no longer have coverage over (they used to have it and my original surgery was covered).

    If it's medically neccesary, should it be covered?

    I am so miserable. I feel like this experience has robbed my youth and my emotional stability (dramatic, I know...)

    Is anyone else going through this? They want $12,000 for the removal! I don't want to give me surgeon a PENNY and would rather go ANYWHERE else.

    I tried to call my insurance and asked them What differentiates Bariatric Surgery from Medically Neccesary surgery? And they told me "We can't find any definitive answers for you."

    I feel like I am living a night mare, anyone else out there in this boat?

    Your band problems are not all that unusual.  What do you think your surgeon did that is causing this?

    I wouldn't dream of self paying $12K to get that thing out of you.  If you can't get it removed under insurance you might consider Mexico.  It's $5K for removal or $11K for removal and revision to a much safer sleeve.

    Sorry, wish I had more to offer.

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    coconut01
    Canada
    RNY (03/01/10)
    Member Since: 04/08/09
    [Latest Posts]
    Post Date: 4/21/10 8:37 am
    I am so sorry you are going through this, I found that when I was researching the band it was very m uch about, get in get out and give us money.  Here it was $16000 when I looked last year, I had a consult, I was not talked to about the dangers or anything really health related, I jsut go the you are a candidate and I am booking for such and such a date.  Well I coul not afford it and finally got my RNY.  My neighbour had the lapband and she did not loose weight for a year, she said they never taught her how to eat and she coul not get in for the fills.  Silly I know, so I am so sorry, I may have been in your shoes if my ex woul have agreed to pay for it.
    HW- 269.5   SW-255  CW- 128.5   Goal - 130  Lost so far ( including optifast) - 141
    Started optifast 15/02/10
    Gastric ByPass 01/03/10
        
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    kishisan
    Idaho Falls, ID
    Member Since: 04/20/10
    [Latest Posts]
    Post Date: 4/21/10 5:09 pm
    I know exactly what you are going though!  I had a lapband and was a success story until it eroded into my stomach.  Since then I have had one after another complication.  I have had at least three abscesses, multiple infections, even pleural effusion requiring chest tube.  It's been a full year since the thing was removed and my health is very poor. 

    Fortunately, my insurance paid for the removal, though they would not pay for the insertion (a relative helped me raise the money to get it initially).  I think that was a choice by the hospital to task the coders to use codes denoting a life-threatening surgical requirement.  That doesn't mean it's been without expense.  I wore a wound-vac for 9 weeks!  I'm still behind paying my portion for that thing.

    I have looked back and wonder if the group that continues to advertise this procedure includes me in their statistics as a failure. 
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    Nic M
    Member Since: 04/14/07
    [Latest Posts]
    Post Date: 5/23/10 8:35 am
    I was wondering how you were doing, Igmariposa. Did you make a decision? Are you doing OK?
    You might need to be kind of imposing when dealing with your insurance company. If you don't fall by the wayside, I bet they will pay for removal. Just keep asking for the sake of your own health.

    I've been thinking about you and hoping you've found some relief.

    Nicci


    "The intimate rapport with nature is one of the most precious things in life. Nature is indeed very close to us; sometimes closer than hands and feet, of which in truth she is but the extension. The emotional appeal of nature is tremendous, sometimes almost more than one can bear."

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