VSG denied by insurance

Well I figured it would happen. The idiot doc that sits behind a desk and holds your life in the balance said no because VSG show's promising results but no long term data has been recorded on it of it's benefits longterm. What I do have is that MD-IPA is my HMO on the federal side and when i popped Dr. Brody up sitting right there in front of my face is someone else that had VSG approved and guess who the insurance company is.......yep MD-IPA HMO. Now they are going to take an ass whippin on this one. Not only that I have about a 10 pound package to send them certified mail along with my appeal letter on VSG benefits above the other surgeries. They have refused the wrong S.O.B. The war has only just begun. I will prevail in this and make them look really stupid. One lady I talked to in benefits yesterday said I have no exclusions on what type of surgery I could have. ......yep got her name too. They will now see the cherokee indian in me come out. I want the VSG because I am a firefighter and the lapband would probably dislodge, slip or flip the port due to the strenuous work I do, and RNY was not an option. They did say they would ok either one of those yesterday though if my surgeon would resubmit the codes for either one and I told them NO I won't stand for it. They ain't seen bad yet, but it's coming. Sorry just needed to rant before battle next week.

Dusty

I am sorry you having such a struggle with your approval.   Is the RNY medically not possible for you?   If so, they should approve the sleeve, I don't understand it.  Perhpas Deb (k9krazzi) can give your some options she is VSG post op and was unable to get the band or the RNy for medical reason and got her sleeved approved.

Good Luck to you

Terri

It's not a medical thing on the RNY. It's just I don't want it because of the nightmare stories I hear about, plus my surgeon doesn't even do them anymore because of the malpractice part of it and that the risk factors are really high and to say he told me his insurance went down when he stopped doing them. I know alot of people on here hasn't had a problem with RNY and I wish them the best but for me i will pass on that one. I just don't like the idea of cutting this and adding it to that and taking this part away lol. Also dumping is not for me.

Dusty,
 Let's see that Cherokee in you, don't take no for an answer!  Does your plan cover the DS?  If they do, then you could argue that the VSG is the first half of the DS.  The second half is frequently done separately when folks decide they want the malabsorptive component to keep the weight off once lost.

Keep in mind that MDIPA/Opt Choice/MAMSI/ United health care are all the same company, and they usually deny the first time. You have to appeal to show them you're not going away.  Keep at'em!

Dusty -

I'm so sorry this happened.  But I applaud you for your "give 'em hell" attitude!!!!  Sometimes, it's clear that they don't realize they're screwing with our lives.  To them, it's just another day.

I know you've done your research and that you've made the right decision for you!! 

Go get 'em!!!  But please know that you're not alone - we're all behind you and will eagerly await updates!!!

Hugs,

Tia

Been there; feel for you! I have TriCare at Johns Hopkins (US Family Health). They have four bariatric surgeons at Bayview and won't cover the VSG. Self pay there is $17,500. Can't come up with that much, so have a date with Dr. Alvarez for $10,000 on 7 October. Good luck with your appeal.

BTW - What do you ride? I have a HD 1200 Custom Sportster. 

Penny 

A 2003 H-D Firefighters Special Edition Ultra Classic

Dusty,

I am sorry about the denial.  I am glad that you have the right attitude to fight them until you get what you want. 
best of luck with the appeal and please keep us posted.

Hang in there buddy!  perseverance will win out over this setback!

Dusty, I am sorry this process is not going smoothly for you. I applaud your spirit and determination. I will keep my fingers crossed for you!

Debbie