Reversal from Band to RnY - Different Requirements? Difficult?

Hi I'm new to this forum and I bet this topic has been discussed before so thank you for your help...I was banded in February, 2008.  It took me 2 1/2 years to lose 80 pounds.  I was at my lowest for a month, and then began gaining back immediately.  Now, 4 years later, I have gained most of my weight back, shy about 20 pounds.  I'm currently about 210 approx (I say that because I'm afraid to get on a scale) and am 5'2".  At my last visit I asked about a reversal to another surgery (hopefully an RnY) and my Dr. agreed.  

My question is - how difficult is it to get a reversal?  Is it harder to get approval for a reversal then it was to get the operation in the first place?  All of the information that my Dr. office requested is in and now its just a matter of waiting.  There are a couple of things that concern me:  1.  a requested proof of 5 years of obesity. I did LOSE weight....so I can't show 5 continuous years of obesity.   2.  My BMI is not at the minimum of 40.  In your opinion are these strikes against me?

I'm trying to keep my emotions out of this post.  Don't mean to sounds like I have no emotional stake in this at all because I do.  I'm trying to deal with just the practicalities of the process.  It is a minimum of a one month wait to hear anything from the insurance company  (so the Dr. office tells me).  And it took the Dr. office a month to contact me with the insurance company's requirements.  So I need to be in this for the long haul.

Any help / suggestions / words of wisdom would be welcome.

Thank you!!

J

It really depends on your insurance company's requirements. 

If there is a medical reason to remove the band, they will probably pay for that.

If you do not meet their requirement for RNY, though, they probably will not pay for that.

All you can do is check with your insurance company, though.

Thanks Kelly.  I've run into some who have had a harder time getting a revision then they did the initial band surgery and others who say requirements have changed and that it is easier.  I suppose its a waiting game.  My Dr. won't service my band anymore so I'm keeping it in even if I don't get approved for the revision (unless other issues develop or get worse) as I feel its better then nothing at all.  Except I'm feeling my GERD now (which I didn't know I had but apparently it was pretty bad).  

Hi there,

I had a revision from lap band (removed in May) to RNY (10 weeks ago July 30th).

My doctor felt I was a good candidate which helped the process along. Additionally, my insurance was going to change by the end of this year so I asked if I could be 'fast tracked' through the process.

His office was excellent about taking care of everything that needed to be done.  I did not have to show a medically supervised weight loss program since basically that's what a lap band is.  I did have to see the nutritionist and psychologist though.   For me it was quite easy to get through the process even though it sure didn't seem like it at the time.  Seemed like it took forever between the band removal and the RNY.

He said he could do them both at once, but his preference was for two separate surgeries to allow time for my stomach to heal after having the band around it for 13+ years.

I don't see where any of those issues are strikes against you.  I think you should candidly ask your doctor those same questions.  It's not like you can do anything about those issues anyway so it shouldn't hurt to ask. (except for the fear of denial. I totally get that!)

I too was told it was a month to hear from the insurance company, but it was actually less than that.  Me pestering them every week probably helped to speed things along.   :)

Keep us posted!

Suz

Thanks, Suz!  My Dr. thinks there are issues with my band...but compared to everyone here, I have it pretty easy (my mom had the lap band a year after I got it and had it out a year ago almost to date).  Thank you!

Four years ago, I had a revision from Lap Band to RNY. Approval for surgery depends on your insurance carrier. Some insurance providers will pay for only 1 WLS surgery during your lifetime.  My insurer approved my surgery because there was a problem with the band.  The revision was treated as though I was having WLS surgery for the first time.  My surgeon removed the band and I went home that evening.   I agreed with his recommendation to wait 3 months for some healing of the band site before doing the RNY.

In my situation, insurance approval or not for a revision, that Lap Band was coming out!! My husband and I were prepared to pay out of pocket for the RNY. If your insurance company denies the revision surgery, have your surgeon appeal. Fight for what you want.  Wishing you the best.

Thank you Tothebest!  I feel like it is driving me crazy so I'm trying to put it out of my mind.  Even thinking of Mexico if I don't get approval...