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My Band has Slipped

balw83
on 1/31/12 6:18 pm - TN
I have had my band for almost 5 years. started having problems, vomitting, reflux, chest pains. Went to DR had my band checked . it has slipped , Dr sent in for a revision to RNY and insurance denied it.What  do I need to do?
Nic M
on 1/31/12 7:11 pm
I'm sorry.

Appeal the denial. Check your insurance (yay, small print!) to make sure you have bariatric coverage first. However, a lot of insurance companies are implementing a "One WLS per lifetime" clause, unfortunately.  Whether they paid for your initial surgery or not, they can deny coverage. You might really have to fight.


If it's still a no-go, you can look into self pay options.

I hope you can find a solution. Good luck to you.

~Nicci

 

 Avoid kemmerling, Green Bay, WI

 

mustangmama
on 2/1/12 5:20 am - TX
RNY on 01/03/12
I had my lapband in 5/2001 and didn't have issues with it until 7-8 years out.  I did have a slip once but an unfill worked to correct it.

I did have the issues you describe plus gastritis, GERD...my surgeon requested the band be removed, not because of band failure, but because of the medical issues I was experiencing as a result of the band.

I'd definitely appeal the denial...and see if your surgeon can conference in with your insurance company to discuss the matter...let him explain the medical issues you're experiencing....have him sight statistics, or whatever....but, definitely APPEAL.

If you want an excellent attorney to handle your appeal, contact Walter and Kelly Lindstrom at obesitylaw.com.  They were instrumental in getting my lapband approved in 2001 after it was denied initially.

Good luck... 
                
Nikki C.
on 2/1/12 11:38 am - Gaithersburg, MD
Did your doctor even give you the option to keep your band since the revision was denied?  Are they covering services for your band maintenance?  If so, perhaps you can have your band repositioned (via surgery if it's a bad slip) or just with a long period of rest with an unfill? 


melly37 might be able to chime in on this and give you some perspective - she had a slip that was repaired by her dr doing surgery! 

If I was denied a revision, I would do everything I possible could to keep my band if I had that option.

I hope the ends well for you! Good luck!


 


 

MARIA F.
on 2/1/12 2:44 pm - Athens, GA

You know ppl on this forum want to continually act like I don't know what I'm talking about when I say almost no one makes it 5 years with a band! And yet here we have another example!

Anyway.........back to your slip. Now first of all, why did the insurance company deny it? Many insurance companies have implemented a "one WLS per lifetime" stipulation to their policies, so if this is the case you are SCREWED! If not, then you need to appeal. I have a couple of links that have insurance and appeal info. One even has a sample appeal letter:

Bariatric Surgery Insurance Appeal


Weight Loss Surgery Insurance Approval Resource


Try those. There is some good info in there. And it would also be to your benefit to join the failed band group. There is a link to that below.


 

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