Dumb Question I know!!!

[rroswelltx 1]

Is RNY the same as Gastric Bypass? If so why would an insurance company choose that over lapband, that doesn't make sense to me... Any thoughts?

[HeatherGurl 0]

Yes RNY is the Gastric Bypass. My guessing as to why the insurance companies choose it is just because Dr.'s have been doing it in the US longer???? Just my guess???

[Anwyn 0]

Actually, the RNY is just one type of the gastric bypass. The duedonal switch is another type (and I believe there are others, but don't quote me on that). RNY and bypass have sorta become synonymous on this board because the RNY is so popular in the US.

It's a mystery to me why more insurance companies aren't covering the band. I think it's very short sighted, but it's not unusual for the newer techniques to take time to gain acceptance.

[rroswelltx 1]

I just don't get it, my insurance has this in their clinic policy:

Vertical Banded Gastroplasty (VBG) and Laparoscopic Adjustable Silicone Gastric Banding (LASGB or Lap-Band):

Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) or laparoscopic adjustable silicone gastric banding (LASGB, Lap-Band) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following comorbid medical conditions:

1. Hepatic cirrhosis with elevated liver function tests; or
   
2. Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or
   
3. Radiation enteritis; or
   
4. Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or
   
5. Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV) (see Appendix).

So in otherword you have to have one of these reasons NOT to have RNY before they will cover the band? Sounds crazy!!!

[mjensen1 1]

Because insurance companies have carved out lower payments on a procedure thats been performed for years and years. The band is still new, they havent made those carve-outs yet and have to pay out more.

And tho youd think theyd approve you for a procedure that costs less, yes it does, in the long run. They are watching their profits THIS quarter, not three or four quarters down the road. The band is safer, less invasive and equally effective, so more people are likely to choose it over more invasive procedures. They would have to pay out more up front, before they realized the savings. The average person could change policies every 2.7 years, they might not realize the savings, so they put up all these hurdles and try to keep from approving.

Really makes me want to work on lobbying our state representatives to make coverage for WLS mandatory!

[kt_199 0]

More profitable for the docs and more success for the patients. Trust me, insurance company are ALL about the almighty dollar and when the success rate for the band improves, they will cover it.

Too many people get the band, then continue to drink milkshakes and sweet tea all day and don't see the results of other procedures.

[bandster_gal 0]

I have heard that since the band is removable, that the insurance ismore or less saying, "If we're paying for it, then you're GONNA do it." Make sense? They don't want to give you the option of changing your mind later. I dunno, that's just what a guy said in my doctors waiting room...

[rroswelltx 1]

Check this out, from the earlier post:

Vertical Banded Gastroplasty (VBG) and Laparoscopic Adjustable Silicone Gastric Banding (LASGB or Lap-Band):

Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) or laparoscopic adjustable silicone gastric banding (LASGB, Lap-Band) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following comorbid medical conditions:

1. Hepatic cirrhosis with elevated liver function tests; or
   
2. Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or
   
3. Radiation enteritis; or
   
4. Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or
   
5. Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV) (see Appendix).

I went to consult with my surgeon Friday, he said that him and about 15 other doctors have gone to Aetna's review board about the above requirements, and told them "They have their information backward, these 5 problems make the lap-band higher risk, Aetna is telling there patients you have to have one of these problems not to get RNY and you can have lap-band but the doctors are saying no way!!!!"

My surgeon is AWESOME, he actually said I was the most well prepared, well researched, well documented patient he has had walk through his door in the last 2 years, and he would talk to the medical director of Aetna directly to try to get them to approve me........ I am so excited. Also I know if it's in God's WILL it will happen!!!!!!! You guys on this board had me so prepared and well researched, Thank You sooo much for all being here and sharing all the time. :hail:

[Guest Nyl]

New and confused....I have read on a few threads about people "eating all they want". I am thinking of being banned, but assumed you would have a restriction on how much you could eat. And, just read the milkshake and sweet tea comment. Could anyone tell me more about this?

[rroswelltx 1]

liquids will go straight through the band and if you make high colorie choices like sweet tea and milkshakes you are not going to loose much weight.

[ljbol 0]

I'm on Medicare and was just banded 3-4-08. Just got copy of hosp. bill and Medicare is covering cost of whole surgery. My portion of bill was just 19.00 and that was for the cost of the tv in my room for two days.