time4achange

I was wondering if any sleevers in the Raleigh Nc Area, had any luck with Insurance coverage and any doctors that will fight for you. I have currently finished all my testing, and had scheduled surgery for Nov. 3. Well, yesterday I was hit with a low blow. My Doc originally said he had no probplem getting the sleeve covered and it should be ok, yesterday I was told the he was told on Friday, that my insurance Empire BC/BS of Ny, said that it was considered investigational, and will not cover the sleeve. He said he asked what would be the reasons for them to cover it, he was told if I had a condition that will not allow me to get any of the other surgeries, not just because I do not like them. The bottom line is, he said he would suggest the Gastric Bypass. My heart is broken, I was so close to the sleeve I could taste it. To top it all off, he said that alot of Blue Cross plans are starting to follow the path of medicaid and stop covering any WLS. So, I feel I need to do something quick. I need to know if anyone know another Doctor in my area that will fight for me with my insurance to be sleeved? Has anyone has the experience and actually was able to do it?

First, I want to say, I been lurking behing the seen for quite sometime. I see how everyone is so supportive, and I hope to have the same support system. I have a few questions and concerns. I had decided on lapband, until I stumbled across this site and started learning more about the sleeve. I am completely sold and I have all of you to thank for saving me from making the wrong decision. I am so nervous and scared, just praying everthing work out. The good thing is I had my last Psych. visit today, and I am scheduled for Surgery Nov.3 YAY!!!! I am in Raleigh Nc, my Doc is Jin Yoo, with Duke Hospital. Is it normal not to have a pre-op diet? I was told it was not required. Also, is it hard to maintain on the post-op liquid diet? My biggest fear and question is, how long after surgery can a leak occur? I have Empire BC/BS of New York, has anyone been approved through them? My Doc said to let them handle that and it should not be a problem. Thanks for listening and for the help. Thanks you my new family!!!

I do not know many doctors. I was referred to this one by my back surgeon. He happened to be in the same office. I am gonna start a new post about Doctor's in my area. Thanks so much for your response.

Hello, I went to my pre-testing today with my doc, only to find out that after speaking with my insurance Empire BC/BS of NY, they will not pay for the sleeve, that it was considered investigational. My Doc asked how could it get approved he was told that it had to be medically necessary to the point I coul not get any of the other surgeries. My hubby is totally against the bypass, and I promised my kids that I will not get the bypass.I feel like a liar. I feel like now, I am stuck with the Bypass. I feel so lost and depressed. My heart was so on the sleeve, I dreamed last night, that I had gotten it already. My Doc said he asked around to other Docs to see what they knew, he was told Aetna and United Health care was approving the sleeve, other insurance was hard. I feel stuck and forced to do a surgery I do not want. I know I have to have something and I always said Lapband and Gastic was out. What can you do when your back is up against the wall, and you know surgery is the right option, but the surgery your heart was set on was stripped away, because insurance feel they know what's right for you!!!

I had 2 back surgeries this year 1 in June and 1 in July. So I do take NSAID, my doc just said that he could prescribe something else. I also argued that, for any pain I use Advil or Motrin. The bottom line is, I do not think he is willing to fight it out or me as I was hoping.

Thank you for the replies, at my psych eval I was asked about my support system, I told her that I will have vertical sleeve talk family as a big support system!! I have a BMI of 48. I am getting so excited, just hope my insurance don't damper my happinest!!