vsg , sleeve in Mass with Blue Cross

 ANyone get approved for a sleeve or VSG in Massachusetts as a first line surgery? 

We have blue cross and Hubby was approved fro band or rny but he needs his Advil because he had both knees replaced and has a lot of pain ongoing. 

Working with Newton Wellesley so far but may have to jump to get it done.. anyone with ideas let me know...

Nope, NOT me! 

Although I had no co-morbidities or exsting issues requiring NSAIDs

I appealed several times but got no where - I have heard of folks being approved though... just be persistant and appeal!

But I do

I had my VSG at BIDMC.  Not BCBS though - sorry!  However, I was denied at first - appealed and won with some help!  Shoot me a message if you'd like more info.  I can also say that BIDMC is great when it comes to working with ins companies about VSG.  Good luck!

 We got another appointment with his docs at newton Wellesley to make another pass at it... them may jump over to beth Isreal...I think it is a matter of time and persistence... 

hate the idea of it only being approver for fixing lap band failure... thanks all... sue

I was approved and had surgery in MA. I was denied at first but with help of my doctor I was approved. I have iron absorption issues so that was my saving grace!

Any luck yet? I'm hoping to have a sleeve and am working toward it as if it's a done deal. My surgeon said he's done sleeves on four patients who have BCBS (like me). They're having trouble getting BCBS to actually pay though. I'm visualizing an approval because of all the scar tissue in my lower abdomen from previous gyn surgeries. Don't want to be messing around with that. And with Medicare reviewing the sleeve in February...if they decide to approve then private healthcare will have to follow at some point. I hope. Keeping my fingers crossed, anyway. My next appt is 2/15 and that's when we choose which surgery and submit the insurance application. I wonder if that's when it gets scheduled too. It's so close! And yet so far...

 We got approved yesterday.   
Heres the history,  we were approved for  RNY or band last summer.  
Explained to the surgeon desire for sleeve instead and got letters from other doctors recommending that..( my husband has had dual knee replacement and MUST take advil to function well enough to exercise and stay healthy... big good reason) 
were rejected first pass at that.  the review board voted 3 to 2 so lost that time. 

Went back to surgeon to push.. ( december) he pushed  harder and wrote a stronger letter to the review board  ) and we got it!  

Notable that he was impressed that my hubby had managed to loose a few pounds since last appointment .. thus is trying  hard enough. 

he has Chaghal ( spellcheck? ) at Newton Wellesley Hospital... they have so far been great..  And theit insurance maven is very responsive.

So... first line rny or band was approved immediately upon submission

Appeal for sleeve was denied 3 to 2

Stronger appeal and persistence and commitment paid off with approval.... 

Best of luck My friend!

Congratulations! I'm so happy for you!

I forgot about the NSAID angle--I have grade 4 arthritis in both patellas and need my NSAIDS. Or something that works as well. One more angle to include in the insurance paperwork.

Thank you!

 yep ...nsaids...  they are OUT for both band and RNY... 

Your doc may ask you to go with celebrex and see how that works.. ( which has OTHER side effects too, like all drugs...)  It doesn't take much to convince a doctor tylenol is not the same as advil... but you need to say it anyway. 

GEt letter from the doctor that diagnosed your arthritis and recommends advil... 

I wish I could have had the sleeve too.. because I live in a lot of pain and all i can take is tylenol and just live with it now... 

The sleeve will be front line soon I think... I t just makes more sence than a plastic band... ( but then we get into the LOBBYISt angle... ) 

Good luck and give it another pass... then another  and another,... It seems like forever now.. but your efforts will pay off eventually if you do not give up. 

In spite of my pain... the RNY I had a few years back was by far the best decision I vever made... Wish sleeve was an option... but still worth it. 

Good idea. I'll get a note from the orthopedic surgeon about NSAIDS, and I think I'll ask the dr who did my gyn surgeries if she'll write something about scar tissue and the fact that she did two open surgeries after I'd already had two c-sections. That's got to count for something in the potential risk department. My primary care physician doesn't know I've gone this far yet, unless he's reading the reports that should be filtering back to him. I doubt it. Maybe a letter from him too. Of course this means more appts but it'll be worth the effort if I manage to get approved with the first application. Time to start making a list of everyone I have to call tomorrow, lol.