Thank you so much!! This looks nearly identical to what she read to me but now I have it in a way to request to my Dr. that we move forward and hopefully he will submit it. I wonder though what they mean precisely by "break down of the pouch".

Thanks again!

I called my insurance about a year ago to ask about revision. They were extremely vague and left me with no idea whether or not I would be approved. Does anyone know how to narrow it all down to get the right answers? First of all what do I ask to learn if there is a "one surgery for life" exclusion? Next how do I find out if I can get approved under a BMI of 40 if it is to revise? Also does anyone know what is considered "medically neccesary" for a lapband removal? I have had two different complications, one that self corrected after a complete unfill according to the Dr. (though I doubt it since just 6 months later I was experiencing the same troubles). I am waiting to see if the latest issue of dialated pouch and esophagus is better or not. I suspect if they tell me all is well then it will not be deemed neccesary to remove it but I still want to request a revision if this is just going to continue to be a problem. Any thoughts would be helpful.

Thanks!
Sarah

Were you PPO? When I spoke to his office earlier they said that they do not work with Blue Shield medical groups just direct like PPO. She suggested that some clients have gone with an out of network referral or something like that. Any thoughts on how to do that?

Ok so I had lapband in March of 2009. I did well the first year losing 70lbs in just over 12 months. My second year was mostly maintenence with a few lbs gained, however it started going downhill toward the end of the second year. I started have terrible burning when eating, my iron levels went wacky, and so I was completely unfilled and sent for an endoscopy. Since they took 2+ months to get around to doing the endoscopy there was never any official proof of an ulcer, but it was assumed that there was one based on the symptoms. After 3 months I finally started getting fills again but as you know that is a slow process so 4+ months later I was gaining fairly quickly. Then I finally started getting some restriction recently only to start up all of the old issues. Burning while eating, and now I am also getting heartburn, getting stuck, and having back pain (not sure if it relates or not). I am not losing any weight even though I hardly eat much in a sitting, but that is also because I am so hungry all of the time so I am eating more often. I would think I am too tight but I am so hungry.

I dont know what to do. If this is dilation, I think we can safely say an unfill is not going to solve it considering I was unfilled completely for over 3 months early this year and as soon as I got back to restriction the symptoms returned (plus some). So if this is dilation does insurance cover revision or is it deemed my fault? I am with Blueshield of California but I have no idea how to check what is covered in terms of revision, does anyone know how I can look into my insurance coverage or anything else helpful. This is so hard and just awful right now. I really do not know where to begin. My doctor has ordered a repeat upper gi to be done in November since the one I had done 2 months ago showed "borderline dilation" so he wants to have it verified. I am at a loss.

Congratulations on your approval!! Can you tell me what your BMI was when you submitted for the revision and if you dont mind can you please share your experience surrounding the erosion?

I am having some current troubles with my band which may turn out to be an ulcer or it may be erosion. I have been happy with my band for the last near two years so I would hate to have to have it removed.