MsSonja

What I've read, the VSG is successful with all candidates. It started as the 1st part of a 2 part procedure for the extremely high BMI 50+ and many didn't return for the second part, which was either RNY or DS, can't remember. But studies showed they kept losing, and that WL was successful even without the 2nd part. I have had great loss since my surgery, anticipate (and hope) I reach my goal weight by the end of the year (very likely, if I keep the momentum going). We did it!

I have Aetna. I initiated the call the day after the surgeons office submitted the papers. I was told to allow two - three weeks. I got my response in four days. It really depends on the work load; and with lay offs increasing, I would imagine the work load does too.

I know Aetna has recently updated their policy bulletin, as the VSG was just covered as of June 2010. It may now be 2 years for weight history as well. And that's a good thing.

I have Aetna and my experience went fairly well. I had 1st consultation with surgeon in March, was approved in June with every piece of documentation needed; had surgery July 1. When the plan says monthly, they mean once a month, not 30 days. You can have an appt Oct 5, Nov 27 and Dec 3. but you can't have Oct 30, Nov 30 and Jan 1. That 2 day difference will cause you to get denied!! I needed 5 year documented weight charts (go with your highest weight and request med records). They want to see the yo-yo. If you have WW weight card, use it! Even though you can 3 months with physician (& nutritionist) or 6 months alone, it's best to do the 3 mos because the surgeon's office will make sure you've got what you need, if one thing is missing, you're not getting approved. Not even with an appeal. If your surgeon has a nutritionist, go with them instead of your own. They work as a team. The plan requires certain things. If your surgeon requires more, if you don't think it's necessary, such as a sleep study, discuss it. My surgeon requested Iron fusion treatment (not covered and I wasn't paying out of pocket). The success of surgery is dependent on the tests and findings. This is why your surgeon requires additional tests and studies. Furthermore, the plan requires a certain BMI. Higher usually aproved, but lower requires that you suffer from co-morbid conditions, even snoring counts. If you don't have any pain or issues, you can be denied. I don't work for the insurance company, but I am the benefits administrator for my employer. I KNOW some things, but I don't know everything or every plan. Drop me a line if you need some insight. ~~Sonja