Highmark Bcbs Does Not Cover Vsg With Bmi Under 50

[WorkItOutWoman 185]

Hi I am hoping someone can me with direction how to go around the insurance requirement of having a BMI greater than 50 to qualify for VSG. My insurance will cover Gastric bypass for those with BMI 40. I initially called the 800 number for my insurance 4 months ago and was told that they cover VSG hurrahhhh! But after going over the policy myself I found the true BMI requirements for VSG.

I did research and thought the VSG would be the best choice for me. The full gastric bypass scares me and I don't think I can handle the added complications that come with RNY. The thought of "dumping" syndrome gives me hives.

Can anyone give me any advice? I am 5'5 and currently weigh 264.

Thanks!

[BrokeMyHalo 107]

First off, have you talked to your surgeon?

Second visit http://wlsappeals.com/ to learn more about what happens with appeals.

Good luck! I know my surgeon has an insurance coordinator who would help you step by step, but the link I gave you can give you some immediate answers on what to expect if you go forward with appealing.

[WorkItOutWoman 185]

Thanks for the quick reply! I brought up the BMI requirement for my surgery and he assured me that did not sound right to him. I read back through the policy and was still reading VSG creaed as stand alone surgery or in conjunction with Gastric Bypass with super obese patients BMI greater than 50. I spoke with the coordinator and she called my insurance company and congratulated me on being eagle eyed. She started talking to me about the gastric bypass. Sigh...I want the sleeve. She told me they will not pay for it so I have to go another route.

I am headed out to look at your link now. Thanks again.

[BrokeMyHalo 107]

Stick with the sleeve... sadly, 2 of my friends that have had gastric bypass haven't done well. I've worked in bariatrics are a loonngg time... if there is a will, there is a way! Hang in there!