Crap band removal approved but DS denied.... Help!

[DianaCox]

"I had a different ins when I got my band so they can't claim that was my 1 time thing."

Sorry, no - you're wrong. One time per lifetime means no matter who paid for the first surgery.

But if the crapband is causing you trouble NOW, you might want to consider getting it out now, and worrying about the revision in a few months, or after you get different insurance.

Alternatively, since you have vested your right to appeal, you could get the band out at their expense, self-pay for the revision to DS (which will likely be EXPENSIVE) and finish your appeal after you have surgery. You risk LOSING the appeal (that exclusion might be ironclad) and getting stuck with the bill, but you will have your band out and your revision and can continue to live your life without having the whole thing looming over your head.

 

[Amey]

Having my band or and self pay for DS would be amazing. But I don't have the money for that. Dr Simper's office offers a loan service. I did the try it and see option.... It only approved me for 18,000 at almost 600/mth payments which is more than my rent. So that's not an option. I have no idea where I would get that kind of money and a pymt over $100 mth just wouldn't be affordable. I was told by the insurance specialist at the lox local hospital that this was the best insurance plan for be bariatric surgery and she never has a problem with it and they are the best to work with... Unfortunately I don't know if they have a DS surgeon or not yet. And I'm wondering if the fact that I'm looking out of state is a factor. However... I don't know if any surgeons currently in Idaho that do a band to DS revision.

 

[Amey]

My apologies for the choppy weird sentences... I'm typing on my phone and auto correct sucks!! Thanks for your patience with me.

 

[newanatomy]

I don't know if any surgeons currently in Idaho that do a band to DS revision.

None that I know of.

 

[duh_Mom]

Hi @Amey, I had the same issue - fought with the insurance company for 6months and finally said "F it" - I borrowed from my retirement fund - took part as a loan and part as a hardship withdrawal in order to get it paid for. Not sure if you have that, but sometimes we don't think of that as a resource.

 

[Larra]

I don't think the lap band removal counts as a bariatric surgery in the one per lifetime situation, but the original placement of the lap band does count. And Diana is right, it doesn't matter who paid for that lap band, even if YOU paid for it, it counts as your one per lifetime. Cute way for insurers to save money, no?
I think @duh_Mom has made a great suggestion and hope you have such funds available. It sucks to do it, but your health is very important. Over the years, we've seen extreme cases where people without insurance sold or mortgaged their homes to pay for bariatric surgery. It should never come to that, but the reality is that it does.

 

[Amey]

Unfortunately I don't have access to that account of money. I don't own a home and I have very little in my savings and the company I work for doesn't offer 401K.