I had to have emergency lap band removal in February because of major slippage that was cutting off my small intestines (found that out when I had to have some xray test done and the radiologist saw that nothing was moving into my small intestine). My 11 year lap band had to come out straight away.
The dr told me the conversion approval shouldn't be a problem because the band failure was not my fault and I was very successful with it. I just got my denial today and I am so pissed! I have gained 20 pounds in the past 2 months after being stable for 11 years! I have all ready gone up 2 sizes... had to dig out old bras and need new panties etc. The only thing that hasn't changed in size is my socks! LOL
Now we have to go to peer to peer challenge. I called the dr to express my feelings and hope he helps me push for this. It was supposed to be an easy process according to him.
Wish me luck.
UPDATE: Peer to Peer challenge was done today and the insurance denied again. I continue to be depressed and struggle with trying to keep the weight gain at a minimum. The doctor will appeal when they get the denial letter.
Boy do I understand your feelings! I have a 10 year old Lapband and I'm finally having it removed with a conversion to RNY. Most Dr's kinda ignored my pains and complaints. I live in Spain now and the surgeons were shocked that even had a band! They stopped doing them in 2005!
Anyway, I had major issues with my insurance. It took me fighting with them and my surgeon pushing also, but they finally approved it after 2 months. My surgery is this Wednesday may 25.
I will be praying for you as I know what you're going through!!
Best of luck and stay strong!!!
Sadly, I had already gained back all the weight I had lost from the band! I did gain 2-3 pounds while waiting. Stress eating is a problem I'm working on. Lol. I still have a closet full of multiple sizes and it drives my husband nuts! I'm looking forward to getting rid of them all after the RNY.
Stay strong and keep fighting! My surgeon was a huge help in getting the insurance company to agree.
Unless you insurance has "one WLS surgery per lifetime" - it may take time to get approved. But if not - start saving or looking for a loan to get WLS you need.
Hala. RNY 5/14/2008; Happy At Goal =HAG
"I can eat or do anything I want to - as long as I am willing to deal with the consequences"
"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."
I also had band removed and want bypass. My insurance is saying No coverage as some dx code from testing for band failure and/or removing band was my one per lifetime benefit. Seems I can fight this?
I was scheduled for the pre op tests and psyc eval that I need prior to them submitting for Insurance approval but I am now wondering if I should do tests so they can submit as I need something to fight against (denial) right?
Good luck and keep us posted! What insurance?
I am so sorry to hear that insurance is so difficult... have you considered going to Mexico for surgery? It's about half the cost as far as I understand it. I am considering doing it myself IF it will heal the digestive disorders that I have been suffering for the past 4 years, because nothing else seems to work and I am desperate to heal.
I know self-pay sucks. I feel like why do I have insurance if they won't cover the medical care that I need... especially after peer review, OMG. But another option in case you have not thought of it is to take out a loan through CareCredit. Some surgeons even offer interest-free financing. So you can self-pay for the surgery in the USA over time.
All of the agonizing, and weight gain, and possibly the cost of therapy and other medical care potentially can be avoided if you just bite the bullet and self-pay is something to consider.
I wish you well with your decision and your approval.