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Revision Question, Insurance Requirements VBG to.....

eClicker
on 1/12/13 9:42 pm
RNY on 08/06/13 with

Hello,

I had a VBG done in 8/2000 self-pay.  Only lost a total of 60 lbs and started gaining back right away, after about 12 months.

Kept gaining and have been back up to pre WLS weight for several years.  I have had no medical issues except GERD over the years and some food sticking in the ring causing me to have to throw it up to get un-stuck.

I gained the weight back because I learned to eat around the ring with foods that were easy to eat rather than ones I could not eat.

I blame (hate) myself for the weight gain and do not feel like the VBG failed me, I failed to make the most of my tool.

Anyway today I have such bad GERD I think I need to have the ring removed.  I am extremely fearful that  if I just have the ring removed I will gain even  more weight.

Has anyone had insurance cover a revision or conversion with a lower BMI of 35.9. 

What is considered medically necessary?  I have such bad GERD that if I have to I will pay out of pocket to get it fixed.  I have been living on Prilosec for  5 years.    

I am burping constantly and food burns.  My stomach is upset almost all the time.  I would rather not have anything done but it's getting to the point where I feel like I must.   

 

Anyone ever had a VBG revised-converted to another type of weight loss surgery for GERD and weight gain?  Has anyone had their insurance pay for it?  What needs to be wrong for it to be considered medically necessary?

Any insights would be greatly appreciated.

 

Thank you,

Eileen

 

 

MajorMom
on 1/13/13 3:21 am - VA

If they can prove your band slipped it might be considered a mechanical failure and fixing it could be covered as a revision. Worth checking out. Good luck!

--gina

 

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
                                 ******GOAL*******

Starting BMI between 35 and 40ish? 
Join us on the
Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

Price S.
on 1/13/13 5:09 am - Mills River, NC

If the GERD is causing errorsion of the esophogus, that would maybe be a reason for a change, maybe a revision.  Don't want to put you off but there is a revision board and they may know more than we do here.  But come back often and let us know how you are doing.

    LW-Apple-Gold-Small.jpg image by PlicketyCat  66 yrs young, 4'11"  hw  220, goal 120 met at 12 months, cw 129 learning Maintainance

Between 35-40 BMI? join us on the Lightweight board.  the Lightweight Board
      
 

southernlady5464
on 1/13/13 5:45 am

Eileen...

Welcome to the LW group!

At 12 years post op, you are actually 2 years BEYOND what the makers of the lapband recommended for their band. They knew it was not a permanent solution and the lifespan in the fine print of their literature is 10 years.

Mechanical failure is the most common reason for revision. but so is severe GERD (cause that CAN lead to ulcers, etc). Maybe get with a surgeon who does the VSG or DS and see about a revision. You may have to have the band removed and let your throat heal first before going in for another WLS. There is a group who can help

If any of these fit your experience, you have a case to get it removed:

Documented adverse effects

The following are the adverse effects of gastric banding as documented by the FDA.[8]

Band- and port-specific

  • Band slippage/pouch dilation
  • Esophageal dilatation/dysmotility
  • Erosion of the band into the gastric lumen
  • Mechanical malfunctions - port leakage, cracking of the kink-resistant tubing or disruption of the tubing connection from the port to the band
  • Port site pain
  • Port displacement
  • Infection of the fluid within the band
  • Bulging of the port through the skin

Digestive

Body as a whole

Miscellaneous

  • Abnormal healing
  • Alopecia
  • Band intolerance
  • An inability to maintain proper restriction

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

eClicker
on 1/13/13 9:51 am
RNY on 08/06/13 with

Thank you Ladies for the reply's!  I will cruise over to the Revision Board and see if anyone there has any experience.

I appreciate that you all took the time to reply and help me.  I'm going in to see a Dr. tomorrow and possibly schedule a scope to see if I have an ulcer or something else going on.  

 

Thanks again for helping!

Eileen