Can anyone help????

[Mary :) 0]

Hi Everyone ~

I got a call from my surgeon's office and they scheduled me for my first meeting with the surgeon on April 2. I can't believe I have to wait so long but I'm just proud of myself that I've come this far.

Ok, the billing clerk didnt sound too optimistic about me getting the VSG approved. She said that they have only done 4 or 5 VSGs and only 1 person got approved on the first try and the rest were appeals.

I called my insurance company and gave them the code that I saw on this website (43755). He said that the code is in their system but he gave me the run around on whether they would approve it or not. He couldnt tell me if its still considered experimental or now a legit WLS.

I hate having to wait the next two months not knowing if I even have a shot at this surgery. I started relooking at RNY and it still makes me completely uneasy.

Any advice would be great!!!!!

[maxcat 0]

My insurance company still considers it expermental, but if your BMI is over 50 then it can be the first part of a 2 step process. I am going to do all the tests for it and then appeal the decision and go from there. If it is still a no then I am researching surgeons in Mexico and I will have all the medical info I will need and my insurance paid for it. I don't want a band and I don't want my insides rearranged. Every time I think about getting the RNY I have a mini panic attack and when I think about the sleeve I just know it the right thing for me. I know I just have to be patient but when I want something I wanted it yesterday. So I think we both need luck on our side.

Good Luck

[Lee 19]

Hi Maddie,

My facility just started adding the Sleeve. Their gold standard is the RNY, but I have a feeling that may change over the next few years when they see the success of the Sleeve.

Here's what I have discovered when I thought that I'd have to really prove my case for the Sleeve. If you have malabsorption issues, the RNY isn't a good choice. My mother had Celiac Sprue and I told them that I'm beginning to see the signs of it in myself. Also, if you have had a disease that necessitates drugs (chemo type etc), it's harder to do with the RNY. Arthritis? NSAIDS are out with the RNY.

I didn't need my research, my doctor immediately said that the Sleeve is my only option. So I'd say to really look at your medical history and keep researching. Build your own case for why the RNY is a poor choice and the Sleeve is a better option for you. Be prepared if you need to fight about it.

[cajun 46]

Hi Everyone ~

I got a call from my surgeon's office and they scheduled me for my first meeting with the surgeon on April 2. I can't believe I have to wait so long but I'm just proud of myself that I've come this far.

Ok, the billing clerk didnt sound too optimistic about me getting the VSG approved. She said that they have only done 4 or 5 VSGs and only 1 person got approved on the first try and the rest were appeals.

I called my insurance company and gave them the code that I saw on this website (43755). He said that the code is in their system but he gave me the run around on whether they would approve it or not. He couldnt tell me if its still considered experimental or now a legit WLS.

I hate having to wait the next two months not knowing if I even have a shot at this surgery. I started relooking at RNY and it still makes me completely uneasy.

Any advice would be great!!!!!

Let us know what company your insurance is with and those on the forum who have it too may be able to help more.

Mine is Cigna and they don't cover the sleeve. I was not entirely unhappy about it, because I did not want to have to jump through 6-12 months of hoops, tests, waiting, before I could get the sleeve, once I knew that was what I wanted. I had saved up, and did research on surgeons, then made my choice, In a month, I had my sleeve. It was so easy and no arguing with insurance. The cost in Mexico was about half what it would have cost in the US. I paid 8700. Dr Jossart in San Francisco charges 1700 plus the cost of labs etc. In some places it is much higher than that.

I hope you can get your sleeve without too much of a wait. Good luck!

[Mary :) 0]

Thank you for your replies. I always appreciate it!

I live in Buffalo, New York and have Independent Health. My policy does cover weight loss surgery and I pray that I can get the Sleeve.

Does anyone have any experience with this insurance?

[Stacy160 201]

Maddie, I didn't have to deal with insurance myself, but a couple of times I've seen it strongly suggested that the patient (you) call the insurance again and request a Case Manager... apparently that can help things go much more smoothly for you. Good Luck!

[excited2lose 0]

Time may be on your side. I mean-VSG is getting more accepted as each day ends. I was *this* close to getting a lap band because that is what my insurance would pay for. 14 days before my paperwork was sent off, my insurance company started paying for the sleeve. 14 days. To think that I may have ended up with a band makes me feel ill. I KNOW the sleeve is the right thing for me. As for calling the insurance to find out info, I can't help. I had no idea where to even start with that, so I just went ahead and made my appointment and waited it out. I am SO glad I did though because if I hadn't, I wouldn't have my sleeve. SO glad I did! :thumbup:

[cajun 46]

Time may be on your side. I mean-VSG is getting more accepted as each day ends. I was *this* close to getting a lap band because that is what my insurance would pay for. 14 days before my paperwork was sent off, my insurance company started paying for the sleeve. 14 days. To think that I may have ended up with a band makes me feel ill. I KNOW the sleeve is the right thing for me. As for calling the insurance to find out info, I can't help. I had no idea where to even start with that, so I just went ahead and made my appointment and waited it out. I am SO glad I did though because if I hadn't, I wouldn't have my sleeve. SO glad I did! :thumbup:

WOW, that WAS a close call! I can't imagine having a band...to think that you almost did. What relief you must feel! The starts are lining up for you...you'll be skinny soon!

[Mary :) 0]

I have to agree...time might be on my side. I'm hoping that it proves to be true. I have a high BMI (over 50) so I'm hoping that this might help my case as well.

Thanks everyone!

[janagirl33 0]

I was denied by Anthem BCBS for the Sleeve.. However when the offered the RNY I had a few concerns such as the stomach that they leave inside the body cannot be checked for anything such as cancer, lesions or strictures and was told that was right. I would hope that wouldn't happen to anyone but it is possible. To check this left over stomach would have to be through exploratory surgery.. No Way.. That made me too nervous to want to continue with the RNY. With the sleeve the stomach removed is actually removed from the body. gone with the Gherlin.