Hey everyone,

I hope everyone is doing well..

I just wanted to give an update, on Friday I called my surgeons office to find out if they received the approval letter yet with both codes showing approved, they advised they didn't.
I called the insurance company and spoke with a representative to ask if they could fax over the approval letter. He then checked in the system and stated the 2nd procedure code is still under review and my physicians office needs to call them! WTF!? I had been told by 3 people previously that both procedures had been approved and I told him this and he just said he didn't know why they said that. I called the surgeons office and asked for them to call.
The person I spoke with at the insurance called me later on and advised that he spoke with his supervisor and that in fact both procedures were approved. At that point I was frustrated and just gave up for the day.
Luckily, my surgeons office ended up calling and was told it was approved and was told that the approval letter would be faxed, the surgeons office said a tentative surgery date would be May 18th..but I told them that was too soon so I would like to wait until June. Hopefully they received the approval letter and will be calling me on Tuesday to schedule a definite date. I did end up receiving the denial letter for the sleeve on Friday 5/4 in the mail, this was the decision that was made on 5/1. They supposedly approved the sleeve officially on 5/2 but I have yet to see the letter. I thought I would have received in the mail by now. I will keep everyone posted on what happens.
I hope everyone had a great weekend and has a great week ahead!! Thanks for reading.

Hi Everyone,

I hope everyone is having a great week!

I received an automated call from my insurance today and it said I had an inpatient treatment scheduled and wanted to give me additional information. This was left on my voicemail which I thought was strange so I immediately called the insurance to find out what it was about. The customer service representative checked the the Pre-Certification manager and she advised that both procedures had been approved. The lap band removal and the vertical sleeve gastrectomy were both approved as of today 5/2 so my timing was perfect!
 I then called my surgeons office and they told me yesterday they received a fax saying the lap band removal was approved but the sleeve was denied. At that point I was freaking out because I was so excited when they told me I was approved. The reason for the denial on the Sleeve was due to my BMI only being 39.5 at the appointment the surgeon and I discussed the revision but at the time of insurance submission it was 41.5 so they were waiting to hear back from the insurance company. So I decided to called the insurance Pre-Certification line directly rather than the customer service just to make sure and they stated both procedures were approved and there isn't any denial in their system. As of right now, my surgeon's office won't schedule until they receive the official approval letter, which is supposed to be sent out today. I'm praying the insurance didn't provide wrong information but I spoke with 2 different people so I'm feeling pretty confident they are correct. I will keep everyone posted on what happens! Take Care guys!

Hi Everyone,

I had my medical history/physical appointment with the surgeon yesterday, this had to be done before they could submit for insurance approval. I called my insurance company this afternoon and all of the information was received today and is being reviewed. So I will patiently be waiting to hear back from them. I'm really hoping it doesn't end up being denied, but I'm ready to appeal if that happens.
The appointment went well, I was able to ask a lot of questions and things that I was concerned about. The sleeve is fairly new to their office so he advised that they have only done around 40-50 which I think is a decent number to feel safe with him performing this. I did forget to ask if he has done any other band to sleeve revisions so I plan to ask that at my next appointment. He did advise there is a higher chance of having to get the surgery open. They will start out laproscropically but go to doing it open if they are unable to see with the scope. He asked if I would be okay with that but I never really put any thought into this before. I'm only able to get 2-3 weeks off work so I know if they have to do it open that won't be enough time to come back to work. I think I may have to hold off on this until I have better job security. I have been at my present job almost a year but I wasn't an official employee until the end of September so as of right now, I'm not able to get any type of Short Term leave/FMLA until this September. All of this is just making my emotions go crazy. I will keep everyone posted on how the approval process is going and when I hear something back. Thanks for reading!

Hi Everyone,

I just wanted to give a quick update. I'm currently in the process of submitting for revision surgery. My family doctor sent my medical history over last week, it only took her 1 month this time around which was very surprising. I received a call from my surgeons office on Friday 4/20 and was told I had to see the surgeon again for a full medical history/physical with them before they could submit. I have that scheduled for this Thursday. The surgeon I'm going with this time just joined the practice around 6 months ago so I have wrote down a list of questions to ask him as far as his statistics, etc to ask him on Thursday. I really want to find out what the chances are of him not being able to do the sleeve revision during the band removal surgery. There have been quite a few band to sleeve revisions happening recently and I haven't came across anyone that wasn't able to do it in one procedure yet. I would be devastated if I went under and woke up without a band and no revision.
I contacted my insurance company yesterday to find out the policy, they have 15 calendar days to give me a predetermination whether it has been approved/denied. The surgeon should send in for approval by this Friday 4/27 so I should expect to hear something back by 5/11. I'm hoping for a smooth approval and hoping to schedule for surgery by June. Based on my insurance policy requirements to qualify for revision I have a good chance of being approved, especially since my BMI is over 40 still even after losing so much weight with the band. I will keep everyone posted! Thanks for reading.

Hey Everyone,

So the past month or so has been pretty rough. A lot is happening..
My band decided to get really tight about a month ago so I had to get a complete unfill. I only had 1 cc in there to begin with but I had decent restriction with that little amount. I have been able to eat more than I would like, but I'm trying to stick with the eating plan I was following when my band was working for me and I had restriction. I just find myself being hungry all the time now for some reason.
The surgeon decided it would be best to have the band removed since it has been randomly tightening up for no reason on and off for the past 6 months. He recommend revising to the sleeve the same time he goes in and removes the band. I now have to start the whole process over again, pysch eval, dietician visit, 2 year medical history from pcp, etc. It's like I'm a brand new patient seeking to have WLS.  I just have to wait on my family doctor to send my 2 year medical history before they can even submit for insurance approval. I had to wait 3 months for her to send them the first time around, I'm hoping since she knows I'm having complications she will speed the process up a bit  this time. I looked up my insuance requirements for revision and I think I have good a chance of being approved, espcecially since my BMI is right around 40. It is probably a bit higher now, I haven't stepped on a scale in a bit so I'm sure I have gained some. I really hope the approval process goes smoothly, my surgeon was originally worried since most insurances have a 1 surgery per life rule, I'm with the same insurance company I was before but not working for the same employer, so I'm guessing it would a different policy so that rule wouldn't apply. I will just have to wait and see. Well there is more to come..thanks for reading.