Need some advise!!

terry · October 20, 2004

Has anyone heard about the procedure (VBG) Vertical Banding Gastro-- My insurance will not cover the lap-band, but will cover the VBG. I don't know anything about this procedure. If anyone knows anything good or bad I would love to hear it. From what I understand it is the older version of the lap-band. I just don't understand why bs/bs of ga. won't pay for the lap-band.

Thanks in advance for your help!!!!

Hopeless in Georgia!

Terry

leatha_g · October 20, 2004

"The Vertical Banded Gastroplasty (VBG) produces a small gastric pouch that is defined by a stapled partition and empties through a small outlet that is reinforced by a plastic mesh band. The procedure was, for about two decades, the most popular bariatric operation because it was less technically demanding than the malabsorptive operations and produced acceptable weight loss without serious dietary deficits except some rare and still unexplained nutritional neuropathies. Although some surgeons are still doing the operation, its popularity faded as long-term follow-up demonstrated problems. Concerns included erosions and obstructions of the band, less weight loss than the combined procedures, failures of the staple line partitions, and the frequent need for re-operation."

There is an appeal letter by one of our moderators, Alexandria on this site that would be almost perfect for this situation. I wish you luck!

terry · October 20, 2004

Thanks for the informtion you gave me. That's the most I've heard about the VBG. If that was your last choose of surgery would you do it? Since I've already fought one battle with Cigna regarding the lap-band and lost, do you think I have a chance in hell to win with BS/BS? I don't want it to sound like I'm giving up and chosing another prodedure because they will pay for it. When I was trying to go thru Cigna the funny thing was I was to told that it would be payed for it if I followed all the guide lines. Which I did, ALL of them!

Then was told after it went to Intercorp which approves all of Cigna's surgerys, it was not a cover procedure and they do not and never did cover the lap-band. So that's why I kind of reluctant to start the battle with BS/BS when they are saying up front to me that they will NOT cover the lap-band.

Sorry to be venting so much. I really want this to happen. I've already spent $500.00 at the first doctor's office, (which we did not have). My husband is still very upset with me, he feels that I might as well thrown the money out the window. What do you think??? Should I presue BC/BS or just get the VBG???

Thanks again!!

Terry

leatha_g · October 21, 2004

First of all Cigna paid for BOTH of my banding surgeries. However, each policy is different, each employer purchases different type of inclusions/exclusions. So just because mine did, does not mean your would too.

Honestly, that question is one you'll have to answer for yourself. This is a very personal journey and it all depends on how much you want to lose, what your current health status is and what you're willing to go through/give up to have a surgical tool.

I think it's worth appealing, to save your original anatomy, personally. Especially if you can do enough research on the VBG and the band to support statements that the VBG is far more dangerous and the results may not be as good for as long, as the lapband. But it will take determination.

Did you locate Alex's appeal letter? She states perfectly why the lapband is a far safer procedure.

I wish you luck!

Alexandra · October 21, 2004

Hi Terry,

If I were you I'd continue to pursue banding surgery (duh). Leatha mentions my situation, and you'll find my appeal letter in a sticky thread in the Insurance Issues section. But I'd also add that it's really only a matter of time before carriers drop their "investigational/experimental" exclusions. The band was approved in 2001 and in June of 2006 that will be five years. In my experience that's sort of a benchmark for some in the insurance community for accepting "new" procedures.

It's instructive to note, too, that Aetna and many, many other carriers no longer cover VBG because it's ineffective in the long run and has a high complication rate. Despite how it may seem sometimes, it is a fact that carriers have medical people as well as businessmen making their policies. When they decide to stop covering something because it's dangerous and ineffective (as opposed not covering it yet because it's "unproven" or "investigational,") I pay attention.

BC/BS of GA is behind the medical times, and you might want to contact your state insurance department to ask if you have any recourse for appeal. IMO, it's just a matter of time before banding is fully accepted by insurers across the country.

Marimaru · October 21, 2004

I would also recommend fighting for the band. There's people that have fought a few times and finally won their coverage. Also, obesitylaw.com will help with appeals if they think you can win.

But it all depends. Why did you chose the band? Many people chose it because it affects your organs the least out of any of the other surgeries. There are still staples and cuts in your stomach tissue if you get the VGB. Do a google on it, there's all sorts of images and things to help you decide.

Good luck, and let us know.