Does Medi-Cal (California) Medicaid Pay for Band Replacement

msmarrie
on 4/8/17 10:42 pm

Hi, I used to be a member of these forums YEARS ago now I'm back! A little background, I was

A little background, I was banded in 2003 and got to my goal weight of 150 from 311, 290 day of surgery but I felt more comfortable being 170ish. I was banded in Texas, moved to California in 2008 and had my very last fill ever around 2009 because I didn't have the money or insurance that covered fills. Fast forward to 2016, finally had insurance that would cover my band maintenance. Went to get a fill, weight 190 (not bad for no fill in 7 years). Found that I had a swollen esophagus which I had never had any symptoms of. Dr. emptied my band to let my esophagus rest and hopefully heal. I was supposed to wait few months and go for a follow-up and possibly a fill. There was a student in with the Dr during my fluoroscopy and the Dr. was educating him on my now vintage Lap Band. The student had no idea how many cc's my band could hold and honestly I couldn't remember either.

Fast forward to 2016, finally had insurance that would cover my band maintenance. Went to get a fill, weight 190 (not bad for no fill in 7 years). Found that I had a swollen esophagus which I had never had any symptoms of. Dr. emptied my band to let my esophagus rest and hopefully heal. I was supposed to wait a few months and go for a follow-up and possibly a fill. There was a student in with the Dr during my fluoroscopy and the Dr. was educating him on my now "vintage" Lap Band. The student had no idea how many cc's my band could hold or the mechanics of it and honestly I couldn't remember either.

During the interim, I lost my job and was not able to return for follow-up. I will be receiving Medi-cal soon which I know pays for weight loss surgery. My question is does anyone know if Medicaid (Medi-cal) would pay for me to have a newer model? It never occurred to me that my band is now obsolete and I may come across a Dr. who would have no idea what do do with it. Is it even possible for me to get my band replaced at this point?

On a side note, my weight is now 230

Thanks in advance!

Travelher
on 4/11/17 1:58 pm
Revision on 10/04/16

if you are looking for a revision I strongly suggest revision to another surgery. it is the foreign appliance that is irritating your esophagus. mine stretched mine. I know others who developed Barretts esophagus and esophagus dis-motility from the band. my friend with dis-motility can't get a revision because the damage is permanent.

I'll be surprised if your body is having an immune response to the band that any insurance would pay to put in another appliance that is likely to do the same thing. Also there is no band that will last forever...so know that the average band lasts 2-10 years so odds of needing another revision down the road is pretty high. think of them like breast implants...people who get those know they will eventually need to replace them.

the newer models may be different sizes but the mechanics haven't changed significantly so not too sure why they wouldn't know what do do with it.

Band-RNY revision age 49 5'4" HW 260 SW: 244 maintenance range: 140-150 (bf healthy range 23-35%) bf 23.7% (at 137lbs) cw range 137-140. 1st round plastics scheduled April 13, 2018

Pre-op-16lbs (size 18/20...244) M1-16lbs (size 18...228) M2-15.6lbs (size 16/18...212.4) M3-10lbs (size 16..202.4) M4-11.4lbs (size 14...191) M5-10.8lbs (size 12...180.2) M6-8.4 (size 8/10...171.8) M7-6.4 (size 8...165.4 lbs) M8-11.6 (size 6...153.8) M9-5.6 (size 4/6...148.2) M10-5.8 (size 4....142.4) M11-4 (size 2/4...138.4)

msmarrie
on 4/11/17 9:32 pm

Thanks for responding. I wrote a novel in my post so maybe I wasn't clear on some things.

I have had my band for 14 years now and it has been great. I'm not sure where you got the idea I was having an immune response. I don't need a revision but I would like one a. because it has been 14 years since my surgery and b. because I would like to be able to have more restriction since my current band only holds 4cc.

Although the mechanics are the same, my band is significantly smaller than the newer ones and it seems if he mentioned that they position the port differently now but I am not sure. Someone who is not familiar with the smaller, older model and tried to do a blind fill could make the mistake of trying to overfill it and of course, that would not be a good thing.

I am happy with my surgical choice and will be sticking with it. I am not at all interested in having such an invasive surgery or having any portion of my stomach removed.

When I got my band I had a coworker who went in for gastric bypass at the same time, I was back at work and she was still in the hospital for weeks and at home for months due to complications. And after all of that she never had any significant weight loss.

I have another former coworker whose 20 something year old boyfriend ended up in ICU and died on the operating table during bypass surgery.

I have been acquainted with so many people who have either developed major health issues, surgical complications and gaining all of their weight back + (an RN I knew at the hospital where I used to work weighed close to 400 lbs after having previously had bypass surgery).

I'm good with the band.

Travelher
on 4/12/17 5:27 am
Revision on 10/04/16

Got the idea of the immune response because you mentioned repeated swelling of your espophagus. Best of luck to you.

Band-RNY revision age 49 5'4" HW 260 SW: 244 maintenance range: 140-150 (bf healthy range 23-35%) bf 23.7% (at 137lbs) cw range 137-140. 1st round plastics scheduled April 13, 2018

Pre-op-16lbs (size 18/20...244) M1-16lbs (size 18...228) M2-15.6lbs (size 16/18...212.4) M3-10lbs (size 16..202.4) M4-11.4lbs (size 14...191) M5-10.8lbs (size 12...180.2) M6-8.4 (size 8/10...171.8) M7-6.4 (size 8...165.4 lbs) M8-11.6 (size 6...153.8) M9-5.6 (size 4/6...148.2) M10-5.8 (size 4....142.4) M11-4 (size 2/4...138.4)

msmarrie
on 4/22/17 4:23 pm

No, there was no repeated swelling. This was the first and only time I have had any "side effect" from my band.

ladygodiva1228
on 4/12/17 4:53 am - Putnam, CT
Revision on 02/04/15 with

The answer would be no. Unless there is a mechanical failure of the current band insurances will not pay for a new model.

I want to be honest with you. One of the long term complications of the band is esophagus issues. I myself started having issues at around 10 years out. I ended up revising to the bypass.

Please be very careful and aware of issues once you get a fill again. Barrett's esophagus is very serious and leads to throat cancer.

Dr. Sanchez Lapband 9/12/2003
hw305/revision w280/cw197/gw150

Revision from Lap Band to Bypass on 2/4/2015 by Dr. Pohl

    

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