gastrip stapling, gastroplasty = VSG?

[valleyfree 0]

My insurance company states:

Approved surgical procedures may include gastric bypass, gastric stapling, gastroplasty, and the Lap-Band? adjustable gastric banding system.

Any ideas if VSG fits into any of these categories?

[Tracy46545 6]

from what I understand VSG is most like the old gastric stapling only a different part of the stomach is used (the less elastic side) so there is more success with it.

Please don't quote me...I'm often wrong :thumbup1:

Tracy

[valleyfree 0]

Thanks Tracy. I notice that you had terrible reflux....did VSG eliminate that? That is my primary co-morbidity and my best chance for qualifying for surgery. I've been told that the RNY is better than the band for reflux issues, but I wondered if VSG would also do the trick.

[Malaika 50]

Valleyfree - welcome to VST. I can't answer your question about the insurance, I hope that VSG falls under one of those categories and that you qualify for the surgery.

I suffered with GERD for YEARS prior to the VSG surgery - although I still have some trouble with burning if I forget to take my prilosec, I don't have any acid reflux at all since the surgery. You will need to stay on a PPI for at leasts 6 months following your surgery until your stomach figures out it doesn't have to produce as much acid. I'm hoping to be able to get off of it by my 6 month anniversary which is 12/12.

[Tracy46545 6]

ValleyFree,

I'm not sleeved yet....still have the non-functional lapband. I'm self-pay so not having to jump through insurance "hoops". (although...I sure wish I had done the sleeve first instead of wasting $6500 on the band first!).

Oh well, this is my time to invest in myself. I promised myself that since I was taking on major credit card debt to do this, that I would return to college to make my future financial life better and be able to get a job with health insurance. I hope to start Jan 17th but if I don't feel quite prepared that soon then I'll do it the next session.

Tracy

[Felecia 0]

It sounds like you have a really good argument if nothing else :smile: You just have to be willing to Fight! Fight!Fight! Just expect the insurance company to deny first round. And do documentation along the way, MY INSURANCE COMPANY I had spoken with three different people who read the bariatric section over with me and all agreed that it should be covered and when it was submitted for approval was denied. I think it may have helped the appeal that I had all there names and dates that I had spoke with people at their company.

Good luck

[Dickson 3]

I have found it is confusing at best when using terminology. The only sure way to know what is and is not covered is to use the coding system. The code for the sleeve is 43775. Call your insurance give them this code and see if it is a covered benefit. Good luck!

[sleevegenie 0]

i did that and was told if it is medically necessary it is covered, but guess what, when you apply they say sorry, investigational,,, very frustrating i hate to say it but the customer service people give out a LOT of false information