Aetna is covering VSG

[mrlddst 0]

Its official!!! Okay so maybe its not on the bulletin yet, but someone posted TODAY that Aetna approved their sleeve!!!

[sunshine2510 0]

Well that was me and then I checked back with Aetna for the CPT code approved under and it was the 43644 for gastric bypass. So I have called my DR office and reamed them one and advised them to resubmit for my sleeve approval.

[sunshine2510 0]

Aetna states that CPT code 43775 is still under review and the code states "Deny No Exceptions"...

[mrlddst 0]

Aww man, well I will cross my fingers for you!!!!!

[agives130 0]

Its a done deal!

Just got this off the aetna website...clicked on the Last Review Date 4/9/10.

This CPB has been revised to state that sleeve gastrectomy is considered medically necessary when criteria are met. This CPB is revised to provide selection criteria for bariatric surgery for adolescents, based upon criteria from the Pediatric Bariatric Study Group.

:lol0:.

Now I'll be waiting on the official approval letter...hopefully within the next week. I'm soooooooooooooo excited. :thumbup1::lol0::biggrin2:

[WeekendWarrior 0]

Great news. Now if Wellmark BCBS can get off their butts and approve it.

Here's a link to the Aetna policy.

Obesity Surgery

[avilda 2]

WOO HOO!!!! And my paperwork is ready to submit for approval today! That is perfect timing. Thanks for the updates.

Av

[jbmf 0]

I already called my surgeon's office to have them resubmit. She said they just heard also. GREAT FRIDAY!!!

Good luck everyone!:biggrin0:

[morethan 4]

Aetna updated today. VSG is no longer expiremental

[vibris 0]

I have a pre-surgery date of 4/20th with Aetna. I submitted mine last week and I think they held it because they were updating the policy.:thumbup1:l

[agives130 0]

I've been approved & it only took 1 day. =0)

Surgery date- 4/28

Good luck to you all!

[mrlddst 0]

I've been approved & it only took 1 day. =0)

Surgery date- 4/28

Good luck to you all!

Congrats! Did you do the 3 or 6 month requirement?

[eriadne 6]

I noticed that VSG is not one of the procedures that is mentioned for getting revisions. Anyone know if that's maybe an oversight, or if they really won't revise you from, say, a band to VSG? I can't think of any reason why band-to-sleeve would be purposely left out

I'm about 2 months away from getting banded (just got my approval from Aetna within 2 days of them updating their bulletin,) but I am having second thoughts now that VSG is no longer experimental -- especially if VSG isn't on the table for a revision if 2 years down the road I'm not a "loser."

I am optimistic that maybe I'll beat the odds of the band and get to 100% EWL even though my BMI is 50+ and I have PCOS... but I if I wind up 2 years out, still struggling and I *could* have had VSG up front & covered and no option but to self-pay to revise... oy, that would bite. :sad0:

[pnw218 14]

lotusflwr,

I originally was planning to get the band, and then after reading more about it and talking to a lady locally who had the sleeve a year before, I changed to the sleeve. There just appeared to be too many complications and issues with the band. Everyone that I talked to who worked at the clinic, had the sleeve not the band. One of the coordinators had the band and is now revising to the sleeve.

Do what is best for you ~ you are the one who lives with your choice, not us. I would highly suggest you check out the sleeve. It is an amazing tool and quite easy physically.

good luck!

[mrlddst 0]

I noticed that VSG is not one of the procedures that is mentioned for getting revisions. Anyone know if that's maybe an oversight, or if they really won't revise you from, say, a band to VSG? I can't think of any reason why band-to-sleeve would be purposely left out :001_smile:

I'm about 2 months away from getting banded (just got my approval from Aetna within 2 days of them updating their bulletin,) but I am having second thoughts now that VSG is no longer experimental -- especially if VSG isn't on the table for a revision if 2 years down the road I'm not a "loser."

I am optimistic that maybe I'll beat the odds of the band and get to 100% EWL even though my BMI is 50+ and I have PCOS... but I if I wind up 2 years out, still struggling and I *could* have had VSG up front & covered and no option but to self-pay to revise... oy, that would bite. :sad0:

I agree with pnw218. Do what is best for you. I'm glad that you are positive about your outcome with the band but also why do it twice? The decision is definitely a hard one especially if you are having reservations about the VSG. I know that I am a bandster and want to revise to a VSG, if I had it to do over again, I would have just gotten the VSG the first time.