Denial / weight gain ... 9 pounds to lose update...
So as it turns out, the pre-op weight gain had nothing to do with the insurance denying my revision.
BCBS said, even after peer to peer review that my band did not fail, because it is fine. No evidence of pouch dilation. They also said that I do not have adequate documentation that I followed the band post op protocol. This is correct, because I do not have records from where I was banded or where I was filled. Long story, but I tried and failed to get the records. My surgeon was in Mexico and he was shot and killed and the Mexican government sealed all his records. One doctor moved and I tracked him down - actually spoke to him on the phone and he read my clinic note to me over the phone and all it said was "filled... blah blah blah"- nothing about anything other than the fill amount. None of my follow up care seemed to have documented much at all :(
So, they suggested I work with my current surgeon with the band so see if I could get it to work - and then resubmit... ??? Well, my BMI is 41, so if I lose a few pounds I won't qualify for the RNY because I have no comorbidities.
They cancelled my surgery :( and now I have a meeting with the surgeon next Friday to work out a "Battle Plan" as he called it.
I am open to helpful suggestions.................
BCBS said, even after peer to peer review that my band did not fail, because it is fine. No evidence of pouch dilation. They also said that I do not have adequate documentation that I followed the band post op protocol. This is correct, because I do not have records from where I was banded or where I was filled. Long story, but I tried and failed to get the records. My surgeon was in Mexico and he was shot and killed and the Mexican government sealed all his records. One doctor moved and I tracked him down - actually spoke to him on the phone and he read my clinic note to me over the phone and all it said was "filled... blah blah blah"- nothing about anything other than the fill amount. None of my follow up care seemed to have documented much at all :(
So, they suggested I work with my current surgeon with the band so see if I could get it to work - and then resubmit... ??? Well, my BMI is 41, so if I lose a few pounds I won't qualify for the RNY because I have no comorbidities.
They cancelled my surgery :( and now I have a meeting with the surgeon next Friday to work out a "Battle Plan" as he called it.
I am open to helpful suggestions.................
Revision Lapband to RNY 2-6-2013 HW: 286 Pre-Op Diet: 277 Surgery Day: 265 Goal: 155 CW: 155
Plastic surgery 8/28/2014: Brachioplasty, mastopexy, & abdominoplasty.
Plastic surgery 1/27/2015: Butt Lift
Wow, that's the pits. Did you keep a record of your fills. When & how much they put in. I had the band& I kept my own record. Maybe that can be part of your battle plan. Also oi you start now & get a fill then do follow ups for a few months maybe they will accept that. Just don't wait too long or they'll make you repeat your preop stuff, if you did any of it.
Sherrie,
Have you had any medical issues with the band? (vomiting, slippage, shoulder pain, etc.)
I thought my band was a great tool until it slipped and had to be deflated. It made me very ill plus it always was painful in the port area. I had lost 80 pounds when everything went sour with it. I was eating two small meals a day and totally satisfied until the problems started. I threw up when I ate so my esophagus and stomach was internally sore. An endoscope showed the damage done. I started eating icecream even though I'm lactose intolerant because the cold icecream was soothing and didn't come back up. Products like Nexium were of no help when it came to the intermal irritation from vomiting.
If you have had zero medical issues, can you start back to the basics with the band by having it deflated and then starting the fills over while following a restricitive eating plan? My plan was similar to what I do with RNY with the exception of having to take a bunch of vitamins and find ways to get in more protein. Also, is there a good support group in your area to help you stay on track?
I hit my "sweet spot" when the band was only half full but most of my band friends had to have several fills to get the restriction they needed to feel full. I did not drink protein drinks with the band because my band surgeon said not to. I ate protein first and used a small salad plate to measure my serving size. (1/2 lean protein, 1/4 clean vegetables (no butter or fats), 1/4 whole grain). My banded stomach could never eat the entire saucer of food. I did not drink with the meal and waited for at least 30 minutes afterwards. I learned to drink mostly water. I avoided white starches but actually could not eat rice, pasta or bread because it would clog. I love sweets and had to give them up because I couldn't eat just a little. I would live on sweets if not for the consequences.
I don't know if this is of any help. I wish you much success in your weight loss journey.
Have you had any medical issues with the band? (vomiting, slippage, shoulder pain, etc.)
I thought my band was a great tool until it slipped and had to be deflated. It made me very ill plus it always was painful in the port area. I had lost 80 pounds when everything went sour with it. I was eating two small meals a day and totally satisfied until the problems started. I threw up when I ate so my esophagus and stomach was internally sore. An endoscope showed the damage done. I started eating icecream even though I'm lactose intolerant because the cold icecream was soothing and didn't come back up. Products like Nexium were of no help when it came to the intermal irritation from vomiting.
If you have had zero medical issues, can you start back to the basics with the band by having it deflated and then starting the fills over while following a restricitive eating plan? My plan was similar to what I do with RNY with the exception of having to take a bunch of vitamins and find ways to get in more protein. Also, is there a good support group in your area to help you stay on track?
I hit my "sweet spot" when the band was only half full but most of my band friends had to have several fills to get the restriction they needed to feel full. I did not drink protein drinks with the band because my band surgeon said not to. I ate protein first and used a small salad plate to measure my serving size. (1/2 lean protein, 1/4 clean vegetables (no butter or fats), 1/4 whole grain). My banded stomach could never eat the entire saucer of food. I did not drink with the meal and waited for at least 30 minutes afterwards. I learned to drink mostly water. I avoided white starches but actually could not eat rice, pasta or bread because it would clog. I love sweets and had to give them up because I couldn't eat just a little. I would live on sweets if not for the consequences.
I don't know if this is of any help. I wish you much success in your weight loss journey.
Banded Oct 2008: 290
RNY Feb 2012: 245
Dr's set goal: 170 reached Oct 11, 2012
My goal: 160 reached Dec 1, 2012
Today : 145-150
I am half the person I was in 2008.
My band has been deflated since 2009. It was put in in 2005.
I had all kinds of trouble with it, never found a sweet spot and decided not to torture my stomach any more and all the fill taken out.
I firmly believe that letting my pound heal for 3 years means that all looks OK.
I would rather mortgage my house and self pay than put fill back in that plastic devil.
Refux, vomiting, no change in hunger - I could either eat without restriction or choke on water... no sweet spot - it sucked.
If the research that is available now on what "type" of people are more successful with the band would have been available then, I never ever would have gotten it.
Thanks for your input!
I had all kinds of trouble with it, never found a sweet spot and decided not to torture my stomach any more and all the fill taken out.
I firmly believe that letting my pound heal for 3 years means that all looks OK.
I would rather mortgage my house and self pay than put fill back in that plastic devil.
Refux, vomiting, no change in hunger - I could either eat without restriction or choke on water... no sweet spot - it sucked.
If the research that is available now on what "type" of people are more successful with the band would have been available then, I never ever would have gotten it.
Thanks for your input!
Revision Lapband to RNY 2-6-2013 HW: 286 Pre-Op Diet: 277 Surgery Day: 265 Goal: 155 CW: 155
Plastic surgery 8/28/2014: Brachioplasty, mastopexy, & abdominoplasty.
Plastic surgery 1/27/2015: Butt Lift
OH2012
on 9/9/12 5:44 am - OH
on 9/9/12 5:44 am - OH
This sounds like good news to me - maybe not the news hoped for, but good just the same. There is hope:
Hope that with the surgeon's on-going support, there may be progress made without the need for another surgery (since the band looks okay).
Hope that your insurance company will see that you will do what is required of you and,if necessary, approve another procedure to continue your progress (it sounds like they're open to approving it in the future).
Hope that it will happen, when the time is right (I believe that some denials or delays may be in our best interest).
Beat Wishes.
Hope that with the surgeon's on-going support, there may be progress made without the need for another surgery (since the band looks okay).
Hope that your insurance company will see that you will do what is required of you and,if necessary, approve another procedure to continue your progress (it sounds like they're open to approving it in the future).
Hope that it will happen, when the time is right (I believe that some denials or delays may be in our best interest).
Beat Wishes.
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