Hello everyone

[RhondaB129]

hello everyone, I’m Rhonda and I was banded (lap) in 2007. No problems until last year, and it’s been downhill. The Dr now tells me it must come out. Well insurance won’t pay for removal even though medically necessary. My port has become detached from the abdominal wall, according to MD. The area is extremely sensitive to touch. I’m looking for advice of anyone else who’s had similar complications

 

[Munchkin]

You need to get your EOC(evidence of coverage) from your insurance company. It might be available on line. Insurance should pay for this since it is medically necessary. READ the document and get your appeal in ASAP. I bet you will win. It's not your fault the equipment failed.

 

[Larra]

I agree with harrietvane . They may be thinking that this is bariatric surgery, or weight loss surgery, when removing a malfunctioning lap band is not a bariatric operation at all. OTOH, if they have a clause that they won't cover any complications of prior bariatric surgery, you may be stuck. But you won't know one way or another until you read your EOC for yourself. This is not a summary of benefits, it's a lengthy document, like 100 pages or so, that spells out in detail exactly what is covered and what isn't. Ask your HR for it, and keep going up the food chain until you reach someone who knows what you are talking about, keeping in mind that HR works for the company and not for you and you must push and advocate for yourself. Also, don't take the word of some insurance company employee over the phone. Again, they work for the company, not for you, and may not get it right.

 

[southernlady]

Welcome RhondaB129

 

[JackieOnLine]

Hello and Welcome to you, Rhonda

 

[MsJacquiiC]

Welcome RhondaB129 - Glad you're able to login successfully.
Not quite happy about the issue you're facing though - but I absolutely agree with these sentiments:

Insurance should pay for this since it is medically necessary

I'm not very knowledgeable about insurance issues - but your particular circumstance seems an issue that insurance would be compelled to cover. And not only cover - but offer a revision option!

You should definitely consult with your original surgeon, gathering all the information that is available. Send your appeal to insurance and I'm in the camp that bets on approval, especially since the fix/revision surgery would be medically necessary as opposed to being some sort of "cosmetic" procedure.

Best of luck and again = Welcome.

J.

 

[RhondaB129]

Thanks everyone, I tried to pull up ins info online and getting nowhere, I’m checking with HR at work to see if they have copy.

 

[southernlady]

Thanks everyone, I tried to pull up ins info online and getting nowhere, I’m checking with HR at work to see if they have copy.

Unless you are lucky, it's not easily accessible online. It's like they want to hide it from you. Keep digging.

 

[hilary1617]

Hi and welcome RhondaB129 ! I'm so sorry the band is causing issues and agree with all the sentiments above that removal *should* be covered. Hoping it proves to be!