Tricare revision?

I had my lapband done in 09 lost 80 pounds then gained back about 50 pounds and every time i get a fill no matter how much i throw up. so i have a revision request in to tricare for RNY from LAPBAND. did anyone else have this or another revision done with tricare? was it hard to get approval through them? people keep telling me they are going to deny me and its making me sick to my stomach. any stories would be helpful good and bad. 

Thank you

I don't have Tricare but, I would like to say just in case you are denied you need to make sure you are documenting everything  I was banded in 09 also.  I would get a fill and than it would tighten to much and I would need and unfill.  I found out they weren't putting everything in writing that I was telling them I was going thru.  I started to ask and make sure everything was going into their written reports.  Also ask for a copy of the report every time which will save you having to pay for copies later if possible.  To prove medical necessity to get the band removed, I had records showing a total unfill one year out and a scope showing esophagus inflammation and gastritis.  Than at two years I needed another total unfill and as they would add a little they would have to take half back out, every time I got a fill.

If you don't have the documentation start now.  The last nine months I got a fill or unfill every month which showed I wasn't able to handle the band.  Once the band was removed I had the surgery notes and the surgeon took photos to show the medical problems it caused.  

Hopefully this will be a non issue and they will approve the revision.

edited to add;  I had also been tracking all my eating and exercise on Caloriecount.about.com and had 9 months of print outs about and inch thick that my doctor submitted to the insurance company to verify compliance and supervised weight lose.

I have Tricare and I am still in the process of attempting to get my VBG revised. I had my original surgery in 2002. Tricare has changed since I had my original surgery and now they have a one weight loss surgery per lifetime. The only exception to this is if it is medically necessary. I have had issues with my VBG from the beginning. I did lose weight in the beginning, but once I had other complications it all just became a downhill slide and I gained a significant amount back. Tricare denied my request for a revision, and then denied that appeal. I continued to try to appeal that decision and that was denied. I am in the process of appealing yet again and I am waiting to hear from them at this point. I do not know if you will be able to get approval, but I do know that unless you have very strong proof that it is medically necessary it will most likely be very hard. Every situation is different and because you did not lose as much initially they may consider approving you. The best advice I can offer is to make sure that you have documentation of everything you can. The more support you have to prove you need it removed as opposed to you want it removed will be what could make the difference. I wish I had better information. Good luck.

I have Tricare and am having my Lap-Band revised to RNY on May 2.

It wasn't hard to get approval but they didn't pay for my first surgery and I had medical need.

I did submit the following information to my Dr's office at my first visit, and I believe they submitted everything to Tricare as well since it was their first revision on Tricare and the rules just changed this year for them (Tricare).

• My Lap-Band surgery report and all records from my original surgeon
• ALL fill records-this was tricky because I moved and had to talk to three different clinics but I got all of them.
• The report from an EGD I had a few years ago when my insurance requested one because I had been on Nexium for too long in their opinion-I also submitted that letter.
• Any Dr visit to my GP that involved weight loss discussions, we tried a few prescription drugs over the years as well as my constant complaints about heartburn and reflux.  What I did for this was made an appointment and talked to the actual Dr. We were able to pull the list of which dates specifically then they gave me the print outs from my charts.
• My new surgeon needed an upper GI before seeing me for the initial consult so that was there too.
• Weigh****chers weight tracker. I'd read late last year that Tricare has started requesting proof of supervised weight loss attempts so I figured I didn't have anything to lose other than a few hours so I signed up and had just over two  months done when I went for my appointment. 

 After my initial consult I had to have an evaluation with the Nutritionist, this was required by both Tricare and my Dr.  We met for about an  hour and went over my diet history from before my band and of course more recently.  She said that her report would include that I'm a good candidate for revision because I learned a few things-I still don't drink with my meals and limit carbs as well as soda and other drinks with calories or sugar.  She also mentioned that it looked to her like my eating habits had been adapted to the issues I was having with the band so the weight gain I had wasn't surprising to her.

That was on a Thursday and she handed everything off to the insurance coordinator as I was leaving and she said she'd submit it that day.  I got a call the next Wednesday that I was approved and a letter from Tricare confirmed it a few days later.

looks like i might have a long road ahead of me. i potentially avoid the dr most of the time but i guess i will start going in more often. i have had two recent fills and both times i ended up throwing up a bunch, ive had two completly unfills in the past two years but i was pregnant in 2012, which that band caused complications for. Im guessing i will have to get more and more documentation. i weighed about 350 to start with in 09, got down to about 270 gained to 280 and maintained for several years, but i threw up all the time, i just thought it was honestly part of being banded. im so stressed about this whole situation because im going to a civilian dr again. im not near a base. when i was in washington at ft lewis they said while i was pregnant that once i was done and done breastfeeding they would revise my surgery, ive recently found out that it doesnt come out of tricare but the hospital.... so im confused, stressed, and feeling defeated already! sigh. 

I have heard that they have different rules for base hospitals/Dr's so that's probably where the difference is-I read that Tricare will approve a Sleeve or DS if it's done on base, but not by a civilian Dr.

Our closest base doesn't have a hospital facility so it wasn't even an option for us.

I would do my best to stop stressing out though.  Make the appointment to see the Dr and see what they say. If they take Tricare they should know the basics of what you'll need-who knows what you do have record of may be enough. If you have to wait 6 months to pull everything together-at least it's only 6 months and there will be a light at the end of the tunnel. But seeing the Dr and getting some real details will be a good place to start.

Oh, the request is already in. im waiting on tricare, but people keep saying im going to be denied due to previous surgery paid for by tricare. my dr said im an excellent candidate for RNY. and he put in the request to do the surgery. to pull out the band and revise to RNY. I recently read that hospitals on post arent paid by tricare so approval for them is not needed that is why getting it on post is much easier, and if that turns out to be the case i guess ill end up having to travel for surgery. 

Oh, good luck to you then! I'm sure you'll hear fairly soon-but it sounds like you've got a good plan B. Travelling would be worth it I think!

I wonder why it is approved to do the Sleeve or DS on base but not off base?  I wonder if anyone has ever challenged that and won?

"i just thought it was honestly part of being banded" - that is because it IS part of being banded, but it isn't supposed to be.  Unless you are not following band rules.  I was banded in 07 and have had trouble all along.  Most of the 79 pounds I had lost was done via vomiting.

After reading these posts, I am becoming increasingly worried about whether my band take down is going to be approved, I have CHAMPVA.  It isn't Tricare as that is for active duty and retired + family where mine is for military survivors, spouses, etc.  I need to call my surgeons office and see where they are but it has only been 2 weeks so it may be too soon.  I did not know to keep all these records and document everything because I to thought everything was just typical band related stuff.  I wasn't on these boards to know any differently , probably just like you.