List of Insurance companies and VSG coverage policies?

[WeekendWarrior 0]

Does anyone know of a list that shows what insurance companies cover VSG? If not, should we make one and get it made a sticky?

I would like to see a list of Companies, and a link to their obesity insurance policy, whether it is covered, or considered investigational, and if anyone has successfully appealed?

I would think a comprehensive list of companies that do cover it would be good for people appealing a denial.

Maybe this is just too big a task?

Here?s Mine

Wellmark Blue Cross and Blue Shield as of 2/1/2010

http://www.wellmark.com/

Current Policy VSG is considered investigational.

http://www.wellmark.com/Provider/MedPoliciesAndAuthorizations/MedicalPolicies/Policies/obesity_surgery.aspx

Know cases who have appealed

None known at this time.

[sleevegenie 0]

i have been struggling with this same issue, i have HMO and they get to decide but because Anthem Blue Cross consider it investigagtional they denied me. I am faxing my appeal letter on Tuesday, just did the last of my preop, had cardiac stress test today, i cannot get anyone to tell me their obestiy surgery policy, please send good thoughts my way, i really don't want any other procedure, can't afford self pay, i think my letter is pretty good. If Anthem denies my appeal i'll be devastated. How can they still consider it investigational, several companies are starting to approve it?????

[WeekendWarrior 0]

I think this may be the link to your policy.

"The investigational status of these procedures is based on the judgment that there is insufficient evidence to demonstrate that the increased risks of these procedures, compared specifically to the gastric bypass with the Roux-en-Y procedure, are outweighed by a significantly greater reduction in obesity-related morbidities and excess weight loss"

I think you may be able to disprove that the VSG is riskier than RNY.

There is an update positon by the ASMBS (link)

Here's a thread with an appeal and references (link)

I don't know if a list of companies that no longer consider it investigational whould help (this is the reason I started this thread).

I believe Kaiser, and UHC both cover it now.

I also found a thread on appealing. (link) According to this, you have a great chance of winning an appeal in california.

I don't know if we have the same sort of appeal in Iowa.

Hopefully some of the other vets here can chime in with more information, I am a newbie here, and just started looking at WLS.

I wish you great luck in your appeal process, and don't give up!

[sleevegenie 0]

thank you so much, i really appreciate this, it's really the only option for me, i have to fight this, i DO NOT WANT THEM MESSING WITH THE PLUMBING i'm ok with a smaller tummy, that's really all i need i will do the rest, :biggrin2:)