One bariatric surgery per lifetime?

S M
on 7/27/12 8:52 am

So this is from another site, I'm copying and pasting this posters OP and her second post with her insurance company's decision

This is my first post .I originally had my first and in october 2008, it was amazing. I lost 100lbs. I went from 250 to 150 and felt great until I started to get severe acid reflux. especially at night to the point of vomitting in my sleep, and occasionally aspirating. I had my first band removed in november of 2010. there was some scar tissue so my do decided to give it a rest before replacing it. In that 2 month gap of no band i gained 30lbs just looking at food. I had my lap band #2 put in January of 2011 of which I never had any luck with. Any time I had restriction i also had reflux, therefore with no restricyion i continued to gain weight another 10lbs. Finally had a barium swallow done yesterday, and found out today that it was not positioned correctly and it needs to be removed.... so either 3rd times a charm or I will be looking into gastric sleeving.

Now the outcome
So my plan to revise to gastric sleeve failed. My insurance will not cover more than 1 bariatric surgery in my lifetime. So another band it is.

Why is a second surgery to replace Lapband with another Lapband not considered a second surgery? Makes you want to punch their lights out!

Empty 11cc band. Fill 8/10/10 3cc Fill 3/1/11 .5cc total unfill 6/12/12 slightly dilated esophagus, 7/17/12 UGI shows improved motility, no dilation. GES 2/21/13 normal, except for food backing up into esophagus, manometry 4/9/13 severe achalasia, motility 0% consult with Dr Pellegrini 5/30 to determine surgical plan

Caramel_Blond
on 7/27/12 9:32 am

VSG on 08/20/12 with

My best guess is that the replacement lap band was on the basis that the first was defective in some way and caused the scar tissue. My insurance would have given me no grief about about a band to band revision but I have better sense.

Jost Dreams
on 7/27/12 10:14 am

More and more insurance companies are adding this clause which makes it even more important to chose (or choose, sorry got a migraine) the correct surgery the first time. I fought with UHC for 5 months to get my band to RnY revision approved even though the band was removed due to a slip in an emergency surgery. I finally went to my husband's employer who overrode UHC's decision after I explained to HR.

Moral of the story.....since the band has a questionable success rate and the inclusion of the one surgery per lifetime clause....pick the correct surgery the first time. The second one will probably be self pay.

Bette B.
on 7/27/12 12:30 pm

Lap Band on 12/02/03 with

Insurance companies change their coverage almost minute to minute. It's certainly possible that the "one WLS per lifetime" thing shall pass, too.

Banded since 2003, maintaining my weight loss and still knowing I made the right choice for me. If you want information on what life is like for a band success, have questions or need help and suggestions on band life, feel free to message me. Otherwise, just read the Lapband Forum.

S M
on 7/27/12 12:37 pm

REALIZE Band on 05/28/10 with

I get the "one surgery per lifetime" clause, what I don't get is that they WILL pay for a second band surgery, but not a revision (no hardware) to a different surgery...it doesn't make a lot of sense, since they all have similar costs and the band has high follow up costs.

Empty 11cc band. Fill 8/10/10 3cc Fill 3/1/11 .5cc total unfill 6/12/12 slightly dilated esophagus, 7/17/12 UGI shows improved motility, no dilation. GES 2/21/13 normal, except for food backing up into esophagus, manometry 4/9/13 severe achalasia, motility 0% consult with Dr Pellegrini 5/30 to determine surgical plan

Bette B.
on 7/27/12 12:46 pm

Lap Band on 12/02/03 with

I don't get it at all. It's not as if you get one cancer surgery per lifetime, or one c-section per lifetime. Stuff happens. If someone runs into trouble and has to get a bypass or DS reversed, do they block that, too? It's nuts.

Banded since 2003, maintaining my weight loss and still knowing I made the right choice for me. If you want information on what life is like for a band success, have questions or need help and suggestions on band life, feel free to message me. Otherwise, just read the Lapband Forum.

pineview01
on 7/27/12 1:14 pm - Davison, MI

Lap Band on 02/25/09 with

That would be using common since Bette.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13!

minnie_cat
on 7/27/12 2:50 pm

Find out how you can appeal this...sometimes you just have to be stubborn with them. Also, talk to your surgeon's office, perhaps they need to write a better medical justification. Good luck!

pineview01
on 7/27/12 1:06 pm, edited 7/27/12 3:37 pm - Davison, MI

Lap Band on 02/25/09 with

They need to see if the 'Once in a life time' has a, in I might add teeny tiny print, "unless medically nessasary".
My insurance changed to this policy in the middle of my trying to Revise. They will pay to get it out and pay to replace it. They will pay for me to fill and unfill it twice a month. But, they are saying no sleeve.
I will fight as hard as I can but may be out of luck. If my body hates this band it will hate a new one too.
I asked the head of referal why the board voted to have once in a life time. The main reason is because they are getting to many people with bands wanting another surgery.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13!

Cheryl N.
on 7/27/12 1:39 pm - Des Moines, WA

Revision on 08/01/11 with

Well, surgeries are very expensive. My lapband was about 20,000? and my revision to bypass was 35000.

246 in Dec 2008 before banded 1/28/09 at 215 lbs, band crapped 9/09 at 170 lbs and struggled with it and regained to 203 revised to bypass on 8/1/11 and am very happy.

pineview01
on 7/27/12 2:04 pm - Davison, MI

Lap Band on 02/25/09 with

I looked up in my insurance records and they charged over 40K for my lapband. But, they are now paying $200 ever fill and unfill.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13!

melly37
on 7/27/12 9:38 pm - Rio Rancho, NM

VSG on 04/03/12 with

Luckily for me, I was able to get my slip fixed and the 2 years later a revision to the sleeve. I have o say my insurance company is pretty darn good!

LapBand Surgery 01/10/08, Revison to Sleeve 04/03/12

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One bariatric surgery per lifetime?