Anthem Blue Cross PPO

I am wondering if anyone has had VSG covered by ABC?  I was going to do self pay but thought, since it seems as if VSG is becoming more prevalent, maybe I should try them again?  Please let me know your insurance experience.  Thank you.

I don't know anything specific about your insurer, but with your bmi being only 31, you don't meet the NIH criteria for wls, so I doubt that your insurer would cover any form of wls for you. There are surgeons, both in the USA and abroad, who will do your VSG for cash up front, but I know of no insurer who doesn't use the NIH criteria as their minimum standard for wls (and some are more stringent than that, but if someone does meet the NIH criteria they can appeal).

Larra

 I had Anthem Blue Cross PPO and was required to have a BMI of 35 plus 2 comorbidities.  They would not cove the VSG at the time (early 2009).  

Danielle,

Please don't take this the wrong way.  I don't mean it in a mean way but just as a means of help.

First off, with a BMI of only 31, any surgeon who will take your money for WLS is not a surgeon I would want to touch me under any cir****tances because he/she is only in this for money and they don't care how they get it. They are not putting your well being and health above their purses. WLS is, and rightly so should be, for people 100 pounds or more overweight.  Less then that is just reckless/unnecessary surgery.  Your insurance will never pay for it under any cir****tances and you will not be able to appeal it.  At a BMI of 31 even with co-morbidities you will not meet the criteria.

Now, I understand you feel defeated with weight loss in general.  You lose and you gain it back.  You lose and you gain it back.  That is what brought us all here.  But from what I have been reading in your postings, you think WLS is going to solve this problem.  It won't.  Let me repeat.  It won't.  WLS works for your initial large amount of weight loss, which is why it is meant for people who have more than 100 pounds to lose.  After 2 years, let me make this perfectly clear, unless you have completely changed your way of life, you WILL gain your weight back just like every other time.  WLS will not change that.  You will still need to diet and exercise to maintain your weight loss.  WLS is not a cure for not gaining your weight back and it's not an easy way to lose weight.  Just ask some of the people who have had complication after surgery.  Or better yet, go to the memoriam board and read about all those that we have lost.  This is major surgery meant as a last resort when everything else has failed.  But even with that, again, when it is all over and done with, as I said, you must spend the rest of your life, just like everyone else, dieting and exercising.  WLS is not a cure for obesity.

You truly need to do alot more research on what you are wanting to do here and why.  And you need to question why any surgeon would be willing to take your money and put you at such a high level of risk.  Again, I don't mean this to be insulting or nasty.  I am just concerned for you that you are wanting something you truly do not understand.  Please reconsider before you do this.

Stephanie 

Stephanie,

I appreciate your concern and I thank you for your input but I know what I am up against in my future.  Every woman in my family is morbidly obese.  I know what my future holds for me genetically and would rather "head it off at the pass" so to speak.  My weight continues to climb despite all of my efforts to the contrary.  I fully understand that VSG is a tool and that I will need to incorporate good diet and exercise habits and I am willing to do that to reach and maintain my goal.

I know that my BMI puts me in the obese category and not the morbidly obese category yet, I still suffer from back pain, foot pain, knee pain, high blood pressure, acid reflux and so forth.  Why, when I've tried everything under the sun, wouldn't this proven weight loss method be available?  I think that is crazy and the NIH needs to review and revise their standards with insurance companies following suit.  As for a doctor that would "take my money" to perform this surgery on my low BMI, I think that doctor is being progressive and realistic, not greedy.

I have done my research on this and why I want to do it and I do understand all the negatives and positves and I have read all the boards here and on other sites.  I am not entering into this lightly.  Again, I appreciate your input but, unless you know me personally, you have no idea if your opinion regarding my situation is correct or not. 

Danikat, please read this about the surgeon you've chosen.

I have read stoongal's post about Dr. Almanza.  What her sister is going through right now is horrible and I hope she recovers completely real soon.  I have also read this type of situation about other doctor's here in the USA.  Not everyone's experience is or will be the same--be it good or bad.