VSG CPT CODE - Federal BCBS

[RaeZur 0]

I am Pre-op and have switched from Lap-Band to the Vertical Sleeve. To tell you the truth what really convinced me was a friends mother's horrifying experience with the band along with a slippage shared in my support group.

My surgeon is really pushing this procedure, he thinks it is an absolute break-through in the bariatric world, which I tend to agree!

I have Fed BCBS Basic, I reside in VA. Wondering if anyone is in process of insurance approval yet? I have a finish up consult for my Psych Eval Friday and one more lab test (iron) on Monday and then I will be good to go for insurance submittal. I am hoping with this new CPT code being assigned, that insurance companies will take this procedure seriously and start approving it! Fingers are crossed here...

This change is last minute for me, but I think overall it is a better surgery, and will cost me a lot less (not having to be filled and such).

[Classiladi13 0]

:biggrin0:Hi my name is babygirlinokc,

I had a lap band done on 04-04-08. Did not work for me at all. So, 05-20-09 I had the lap band removed and the vsg done. Day and night!!! I love my sleeve. It totally ROCKS!!!

The surgeon that did my sleeve was an out of network provider for Federal BCBS. Doctor told me that I should do self pay. Then Federal BCBS would reimburse me. They said the reimbursement would not be the full amount that I paid for the surgery (12,500.00) but some of it should come back.

Well on the Obesity Help web site there were numerous amount of vsgers claimed Federal BCBS paid for their vsg the full amount. So, that is where I'm at right now. The claim that my doctor turned in had a cpt code of 43659, which Federal BCBS denied.

:biggrin2: They do cover 43843. So, I asked my doctor if he could resubmit my claim with 43843. After researching the

43843 he said yes they would resubmit my claim with the cpt code 43843.

Is anyone out there who had theirs covered at least most of it, by Federal BCBS?

Thanks for responding!!! :thumbup1:

Hi babygirlinokc. I'm one of the unlucky ones who has BCBS insurance coverage but the company I work for has a WLS exclusion clause in the policy. :cursing:. However, I'm responding to your post because based on your location and the amount that you quoted for surgery, I can pretty much bet that you went to the same hospital that I am going to in Edmond. If I am correct, would you mind sharing your experience with the doctor and the facility. I've already had all of my pre-op blood work and all of my consultations. I have to lose some weight before the surgery, so I am currently on an "aggressive" pre op diet right now. (started one week ago and have lost 5 lbs). So far, I am very pleased with the facility, the doctor, and the staff. I have a 2 1/2 hour drive to get there, but since I am self pay, it's about $6,400.00 cheaper, so for me, it's worth it. Thank you in advance for the information. Feel free to email me personally rather than posting here if you prefer. Thanks again!