Insurance Covers Bypass Or Band, How To Get Sleeve?

[erp 2,016]

I have called my insurance (Healthnet h,m,o) and they cover WLS but have several conditions that worry me. first they require all procedures to go through their Bariatric Centers. Has anyone heard of these, dealt with them. Second, they only cover the lap-band or gastric bypass UNLESS some how the doctor proves that the sleeve is medically necessary. Does anyone know how to prove the sleeve is necessary and conversley that these other forms are WLS would be contra-indicated? I really only want the sleeve after doing my research. Lastly, does anyone with Healthnet *** know what the steps are to their approval process. I couldn't figure out if they require dieting, nutrition counseling, classes, etc. thank you!

[Isabel'sGma 18]

The whole bariatric Center is not unique to Healthnet. It is not that bad; however, they will probably have a set of requirements. Find out who their centers of excellence are and locate a physician that has worked with healthnet in the past and talk to their insurance coordinator. They will be best able to advise you.

[DebraLea 16]

My new insurance was the same way. My surgeon had to write them a letter explaining why the sleeve was needed and it worked. First time they always deny it and tell you bypass or band. Its a game and you have to play it to get what you want. Don't give up. Play the stupid game.

I have worked in healthcare for over 25 years and have seen the changes to patient oriented services to the demi gods deciding who gets whats and it sucks.

Heres something most don't know, the people making those decisions aren't even qualified to make them. They are just people off the streets hired into the positions, no medical knowledge or experience whatsoever. Damned scary.

Insist on the sleeve I did and I would not have had the surgery if I couldn't have gotten it.

[sleevemeup 41]

I am in the same boat. Fortunately, I am with a small employee funded insurance, and have been for almost 10 years. They have said that they will take a look at the sleeve if it is better for me... we shall see. They have covered all of the problems that I have had due to my weight problem including medicines and several surgeries. I am hoping that those problems will convince them that the sleeve is for me. My surgeon is writing a letter stating that it is the best option for me. Fingers and toes crossed!

[pia 2]

Question for the respondents of this thread. Why did you pick the sleeve over the bypass and what did you say to convince your doctor and the insurance company that the sleeve was best for you? I'm want the sleeve but my doc is trying to encourage the bypass though she said itsnupnto me.

[petite-size-me! 70]

Question for the respondents of this thread. Why did you pick the sleeve over the bypass and what did you say to convince your doctor and the insurance company that the sleeve was best for you? I'm want the sleeve but my doc is trying to encourage the bypass though she said itsnupnto me.

I wouldn't have had the surgery if anything but sleeve. Banding has too much on going care and RNY (bypass) has long term health effects like malabsorption.

That is from my research and is my opinion. Looking forward to seeing others

[sleevemeup 41]

Great question... I was open to the best option for me. With the bypass, you absolutely cannot take certain meds that I sometimes need to take. I have had multiple surgeries on my legs from sports and now from injuries sustained due to my weight. I have also had some inflammation issues with autoimmune conditions. Should I need to take prednisone or anti-inflammatories, I can under strict supervision. If I had the bypass, from what I was told I can't take those period. When I had my consult, we discussed all of my options and came to the conclusion that this is my best option.

The sleeve is new. From what I was told, it is becoming more popular in Europe than bypass. True, the long term studies have not concluded, maybe that is why.