Ugh - big setback today! :(

[SuzKelly 0]

We are in so much debt right now - there's NO way I can dig our hole any deeper. Believe me, I toyed with that idea, but I just couldn't do that.

[Oregon Rose 2]

Hi SuzKelly-

I really feel for you. I felt like I had to jump through hoops, and I felt jerked around when I was trying to qualify for my wonderful insurance benefits. I had to go through a six months documented weight loss program.

During the time I was trying to qualify for the 'benefits," I did a lot of reading on the various bariatric procedures available. Of the procedures available, my insurance company would only cover the Band, Roux-En-Y Gastric Bypass, and an outdated technique that no self-respecting surgeon would do anymore.

So around the sixth month and 17 pounds of weight loss, I decided that VSG was the best procedure out there, and my best chance for losing the weight and KEEPING IT OFF! People with he Band and Gastric Bypass still have all of their stomachs. Their bodies can produce lots of ghrelin which makes one very hungry. With VSG most of the stomach is removed. Even if our bodies compensate by producing more ghrelin in the remaining stomach, I don't think it will be able to produce enough to make us as hungry and the Band and Bypass people get after a year or so.

So, I decided to self-pay. Fortunately, we have very little debt.

Since you have a lot of debt, it seems you best choice is to try to fight the insurance company. Try to document as many co-morbidities as you can and get started on your six month documented weight loss attempt. Some insurance companies are starting to cover VSG, but not most. You might find out by posting a query on this web site which insurance companies have paid for VSG. Naming the other insurance companies that are covering this procedure might aid your argument with your insurance company.

Best wishes for success with your insurance company!

[cajun 46]

Suz,

I am so sorry you are having to deal with this roadblock. Don't let it stop you. Many, many insurance companies issue a denial the first time an application comes in. The key is to reapply, and give them even more evidence that this will save them money in the end because many of your comorbidities will likely fade away after this treatment.

Read the article at SpringerLink - Journal Article

It might help.

[SuzKelly 0]

Thank you so much for your kinds words :)

I Just got back from my second visit to the psychologist - and we had good long talk. I am going to go see someone about the RNY. I am feeling much better now.