Aetna is covering VSG

[eriadne 6]

Thanks for all the positive encouragement. I called my surgeon's office today to make sure he actively does sleeves and they said he did (and prefers them) and offered to re-submit my paperwork if that's the route I want to go.

I asked for an appointment to talk with my surgeon about what he recommends and also to get an opportunity for both my husband and me to ask questions... just want to make an informed decision, you know? :001_smile: I have all kinds of blood issues, so when I initially talked to the surgeon about RNY vs. band, that did play a factor for both of us leaning toward the band.

I am thrilled to have options for once, but it can be a bit overwhelming, even for someone who researches all this stuff like crazy before diving in. I'm glad Aetna made some big changes to their obesity surgery policies, but it's got me in a whirlwind at the moment. :sad0:

[jbmf 0]

Lotusflwr, Just curious on what surgery you decided on. I'm having my VSG May 10th. I have no doubts this is the surgery for me. Just wanted give you well wishes for whatever you decide.

[Tiffykins 673]

Thanks for all the positive encouragement. I called my surgeon's office today to make sure he actively does sleeves and they said he did (and prefers them) and offered to re-submit my paperwork if that's the route I want to go.

I asked for an appointment to talk with my surgeon about what he recommends and also to get an opportunity for both my husband and me to ask questions... just want to make an informed decision, you know? :confused: I have all kinds of blood issues, so when I initially talked to the surgeon about RNY vs. band, that did play a factor for both of us leaning toward the band.

I am thrilled to have options for once, but it can be a bit overwhelming, even for someone who researches all this stuff like crazy before diving in. I'm glad Aetna made some big changes to their obesity surgery policies, but it's got me in a whirlwind at the moment.

It is really overwhelming. I've had the band and now the sleeve. Just from my experience, the sleeve is fabulous. I would say to research the good, bad and ugly of the band. I thought I would be one of the lucky ones and beat the statistics with the band. Unfortunately, I only had my band 8 months, and then revised to the sleeve. I do not regret my band decision because it taught me a lot about myself, and my eating habits. But, it damaged my stomach tissue, it was a horrific experience. My quality of life was in the toilet.

Here is some interesting information from the band manufacturers.

1 in 4 band patients will have to have another surgery to repair a band issue, or remove it entirely.

It now has the lowest and slowest weight loss results.

Also, I have never found one band patient that has had their band for at least 10 years without a slip, or other major complication at some point. I did find one patient on OH that has had her band for 9 years, but she is now seeking a revision because of the chronic issues she's struggled with over those years. She had her band replaced once around the 5 or 6 year mark because the band leaked and she lost restriction.

http://www.lapband.com/en/learn_about_lapband/safety_informa tion/

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function) occurred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you dont understand.

Back to Top What are the specific risks and possible complications?

Talk to your doctor about all of the following risks and complications:

• Ulceration
  
• Gastritis (irritated stomach tissue)
  
• Gastroesophageal reflux (regurgitation)
  
• Heartburn
  
• Gas bloat
  
• Dysphagia (difficulty swallowing)
  
• Dehydration
  
• Constipation
  
• Weight regain
  
• Death
  

Laparoscopic surgery has its own set of possible problems. They include:

• Spleen or liver damage (sometimes requiring spleen removal)
  
• Damage to major blood vessels
  
• Lung problems
  
• Thrombosis (blood clots)
  
• Rupture of the wound
  
• Perforation of the stomach or esophagus during surgery
  

Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.

There are also problems that can occur that are directly related to the LAP-BAND? System:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
  
• The band can slip
  
• There can be stomach slippage
  
• The stomach pouch can enlarge
  
• The stoma (stomach outlet) can be blocked
  
• The band can erode into the stomach
  

Obstruction of the stomach can be caused by:

• Food
  
• Swelling
  
• Improper placement of the band
  
• The band being over-inflated
  
• Band or stomach slippage
  
• Stomach pouch twisting
  
• Stomach pouch enlargement
  

There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:

• Improper placement of the band
  
• The band being tightened too much
  
• Stoma obstruction
  
• Binge eating
  
• Excessive vomiting
  

Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the LAP-BAND? System is typically slower and more gradual than with some other weight loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

• Malnutrition
  
• Anemia
  
• Related complications
  

It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.

If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.

If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barretts esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the LAP-BAND? System surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.

Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.

Some people need folate and Vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.

You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.

There have been no reports of autoimmune disease with the use of the LAP-BAND? System. Autoimmune diseases and connective tissue disorders, though, have been reported after long-term implantation of other silicone devices. These problems can include systemic lupus erythematosus and scleroderma. At this time, there is no conclusive clinical evidence that supports a relationship between connective-tissue disorders and silicone implants. Long-term studies to further evaluate this possibility are still being done. You should know, though, that if autoimmune symptoms develop after the band is in place, you may need treatment. The band may also need to be removed. Talk with your surgeon about this possibility. Also, if you have symptoms of autoimmune disease now, the LAP-BAND? System may not be right for you.

Back to Top Removing the LAP-BAND? System

If the LAP-BAND? System has been placed laparoscopically, it may be possible to remove it the same way. This is an advantage of the LAP-BAND? System. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.

At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.

[eriadne 6]

As of today, I'm officially going with the sleeve. I talked it over with the surgeon a few weeks ago and he was positive it'd be a better option for me, and I am actually more comfortable with the idea of VSG over the band.

It took Aetna about 3 weeks to switch my band surgery approval to a sleeve surgery approval if anyone with Aetna finds themselves in a similar situation. There was no extra work or anything required on my part, just patience!

[6kiddos 18]

What Aetna plan doesn't require the 6 mo diet?

[avilda 2]

Mine doesen't... required 3 months.

[6kiddos 18]

avilda - did you call them and ask? I was told at the seminar that Aetna always requires 6 months. I have an individual ppo plan so some things are handled differently.

[mrlddst 0]

avilda - did you call them and ask? I was told at the seminar that Aetna always requires 6 months. I have an individual ppo plan so some things are handled differently.

I know your asknig avilda, but I have Aetna as well and they will take either. The 3 mos is supposed to be more intense followups with your nutrionist, fitness trainer and your pcp.

[avilda 2]

My surgeon's office handled it. I attended 3 group style meetings with the nut. and my seminar. That is all I had to do. You might call them and ask... but lots of plans are different. Good luck.

[Jackie100 0]

I thought you all may want to see the infor below..

Insurance Company to Cover Newer Method of Bariatric Surgery

by Kerri Seidler on April 21, 2010 ? Comments | Weight Loss Surgery

Aetna, one of the nations largest health insurers, revised its policy on obesity surgery this month to include open and laparoscopic sleeve gastrectomy among its covered bariatric procedures.

The sleeve gastrectomy procedure, often referred to as the gastric sleeve, is a newer method of bariatric surgery that is gaining in popularity as a treatment for morbid obesity.

The gastric sleeve promotes weight loss by reducing the size of the stomach to help patients eat less and feel full faster. It appeals to many patients as it does not require a medical implant or need adjustments like laparoscopic adjustable gastric banding and does not require cutting and rerouting the small intestine like the gastric bypass procedures.

Prior to the policy change, Aetna considered the sleeve gastrectomy ?investigational? and did not cover the surgery. As of 4/9/2010, Aetna revised its Clinical Policy Bulletin for Obesity Surgery and stated that the ?sleeve gastrectomy is considered medically necessary when criteria are met.?

The policy now reads: Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy, open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB) medically necessary when the selection criteria listed below are met.

Although the sleeve gastrectomy is included under bariatric procedures, coverage for obesity surgery is still dependent on benefit plan details and approval by Aetna.

Aetna?s decision follows in the footsteps of United Healthcare, another healthcare giant, which began covering the procedure in October 2009.

In response to the Aetna and United Healthcare change in policy, The American Society for Metabolic and Bariatric Surgery (ASMBS) issued a press release announcing its support. In the statement, John W. Baker, MD, FACS, President of ASMBS, said ?We are pleased that Aetna and United Healthcare now includes sleeve gastrectomy among its covered bariatric procedures?Sleeve gastrectomy has now reached that threshold where the data and our experience with the procedure supports its safe and effective use in people affected by the chronic disease of morbid obesity.?

The ASMBS, which is the largest organization for bariatric surgeons in the world, is a non-profit group committed to educating medical professionals, patients, and the general public to the various effects, risks, and benefits of bariatric surgery.

The decision of Aetna and United Healthcare to cover gastric sleeve will benefits patients who are morbidly obese and considering weight loss surgery. While weight loss surgery is the most effective treatment for morbid obesity, it should not be considered a ?one size fits all? approach. As the best surgical intervention for obesity can vary from patient to patient, insurers who cover a wider range of options will better allow surgeons to treat patients on a more personal basis.

[Jackie100 0]

Hi,

Please tell me what your surgeon had to ask to be approved by Aetna.. the girl at my surgeons office keeps telling me she knows Aetna will deny me without a psych evaluation. I did one yesterday.. I hope I get approved.. I have seen a nutritionist and my pcp has written a letter of medical necessity.

Thank you.

[SouthernSleever 228]

I am thinking of getting a job that offers Aetna. I have UHC but the plan we have doesn't cover obesity services. I'd hate to get a job only to find out they don't cover VSG also. Anythoughts?

[lil red raider 5]

I have Aetna Select. I had to do 3 months of physician supervised diet, 1 nutritional eval, one psych eval, and exercise evals. I had my last weigh in on June 9 and had my approval by noon on the 11th. I met the criteria alone with my BMI. Aetna requires a BMI of 40 or above or 35 with two co morbidities (high bp, obstructed sleep apnea, etc). My dr.s office was all in one so I had one co pay to see the dr., nutrtionist, and physical therapist.