Revision Question, Insurance Requirements VBG to.....
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.
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!
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.
Between 35-40 BMI? join us on the Lightweight board. the Lightweight Board
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.
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
- Nausea and/or vomiting
- Gastroesophageal reflux
- Stoma obstruction
- Abnormal stools
Body as a whole
- Abdominal pain
- Chest pain
- Incisional infection
- Incision pain
- Blood clots
- Hair loss
- Gall stones
- Abnormal healing
- Band intolerance
- An inability to maintain proper restriction
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!