If removal of my band is medically necessary, why would insurance not cover it?

I have had my band for 8 years. Was self pay.

I have different medical insurance, but they also have WLS exclusion.

Having a lot of problems with reflux and gaging. Having Endo tomorrow. But Dr. office thinks will have to have band out right away.

Then rest before revision. I asked the insurance girl at the Dr. s office since its medically necessary to remove the band would the insurance NOT cover it and she replied that once an exclusion, always an exclusion. Even if it was life or death.

Is this correct? I tried to contact them, but they said they would have to have codes to tell me if it was covered.

Don't you think the Dr.s office should try?

Yes. I think I would at least want them to try.  Also, grab a copy of your summary plan description and contact Lindstrom or other legal help.  I would think that the lap-band would be a pre-existing condition....

Yes it is very possible that they will not pay for removal but at this point you really have no choice, sometimes the docs can fudge the surgery code but then that puts him in jeopardy of getting in trouble with the insurance co. My band has been empty for over 2 yrs just trying to put off getting it out because I have an exclusion on any bariatric surgery. I'm not having any issues tho since my band was emptied so mine isn't an urgent situation but yours is very urgent! I know many, many people who are in my same situation, the band not working but having no coverage. I wish I could get this thru to the newbies who insist that "they" won't have any problems because they will follow the rules! As we know a person can follow every rule and still have serious problems.

It depends on the insurance!  There are ways to get "exclusions" covered.

Good move!

From what I've read about them Lindstrom is the best and if anybody can get it covered they can. Good luck!

There is a chance the removal only could be covered, particularly if something life threatening is going on, but not the revision. 

Self pay or not, the "once in a lifetime" exclusion is exactly that, regardless of who paid. 

Im sorry you are going through all of this. I think that is so crazy of the insurance companies.  I understand why they do it to a certain extent.  What i don't understand is how do they get to dodge the bullet saying 1 weight loss surgery no matters who pays.  How can they say because someone else put money out on it we don't have to?  That doesn't even sound right.  So what if a person who self paid or had different insurance just goes through the process meeting all the requirements for a weight loss surgery and the surgeon submits it as a new surgery and not a revision. Then does that make it possible?  With a band removal how can that be considered a WLS man these insurance companies stick it to you going and coming.  I have to say I thank God for my CIGNA has been good to me through out the years.  Hopefully my luck/ God's favor will continue and I will be approved for the DS.

usually a weight loss surgery exclusion means the employer did not pay for the "rider" for weight loss surgery  so usually unless the removal is life or death unfortunatly that means they will not pay.