Sleeve surgery, approved, by, insurance,?

[LAN2k 0]

Wow got it! If anyone else is interested for insurance coverage inquiries, the procedure code for the Sleeve Gastrectomy is 43659.

[WASaBubbleButt 41]

Would anyone here happen to know the Procedure Code for the Vertical Sleeve procedure? I have contacted Oxford Medicare to make inquiry and need the procedure code.

CPT Code 43843

[schatzie 0]

I said maybe it will be approved.

[LAN2k 0]

If a request is made to insurance company for the Lap Band procedure and it is approved but before one has the actual surgery one decides to submit a request for approval for the Sleeve instead with a different doctor, will the insurance company consider the change in procedure for approval?

[WASaBubbleButt 41]

If a request is made to insurance company for the Lap Band procedure and it is approved but before one has the actual surgery one decides to submit a request for approval for the Sleeve instead with a different doctor, will the insurance company consider the change in procedure for approval?

It depends on if your ins co covers the sleeve. If they do you can have surgery by any of their contracted doctors and covered procedures.

[circa 0]

This is what Priority Health says regarding VSG:

C. Limitations

1. The following bariatric procedures are covered when the surgical criteria

above have been met:

a. Roux-en-Y gastrojejunostomy

b. Laparoscopically Adjustable Banding with FDA approved device

c. Biliopancreatic Diversion with Duodenal Switch (BPD/DS) (For

Medicaid, see #6 below).

d. Sleeve gastrectomy IF one of the following applies (For Medicaid, see #6

below):

(i) A Roux-en-Y gastric bypass is contraindicated (e.g. severe

adhesions, previous bowel surgery) and the patient is either not

desirous of or not a candidate for any other covered procedure

(laparoscopically banded gastroplasty or biliopancreatic diversion

with duodenal switch ), OR

(ii) The sleeve gastrectomy is an integral part of another planned

covered procedure (i.e. duodenal switch procedure), but only if the

sleeve gastrectomy is performed because intraoperative

complications preclude the completion of the duodenal switch

procedure itself.

So I see the way around if the surgeon is willing - but holy crap! Why such a big ordeal for a surgery that's been around literally forever? heheh

Any advice on how I approach this with my surgeon?