VSG denied by insurance

renegadebkr
on 8/25/08 8:14 am - Waldorf, MD
My thanks to all my family on Obesity help. Boy what a great bunch of people, couldn't ask for better friends. I think reading this everyday put the fight in me to pursue what I want.
Dusty Cassidy   " It's not a real adventure unless you come home with a scar "                    
Current weight  219.0 Lbs   My  Ideal weight  188   I love my sleeve 
                                
(deactivated member)
on 8/26/08 12:32 am - Millersville, MD
is your heart set on this surgeon?  because.. honestly... if my surgeon's office wasn't doing most of the fighting for me... i would find another surgeon. 
renegadebkr
on 8/26/08 10:48 pm - Waldorf, MD
Even my surgeons office told me that insurance companies aren't ok'ing this surgery because they try to deem it experimental. My surgeons office is great they fought with MD-IPA for 3 days over this so I don't have a problem with my surgeon at all, very well respected and seasoned and I will stick with him because I don't want to start over with someone else. He was one of the surgeons that had GWU deemed a Bariatric center of excellence. The problem lays with these damn insurance companies just not wanting to pay for the surgery regardless what surgery it is. They will pay for the lap band and RNY but not VSG. I now have proof that they paid for a revision surgery ( Lap band - VSG ) so the only thing they did when they approved that was leave themselves wide open for a lawsuit and my lawyer is standing by for that if necessary. Also I have no surgery exclusions under the weight loss surgery section it doesn't list specific ones that you can't have so that is one more chalk mark in my favor.
Dusty Cassidy   " It's not a real adventure unless you come home with a scar "                    
Current weight  219.0 Lbs   My  Ideal weight  188   I love my sleeve 
                                
(deactivated member)
on 8/27/08 8:28 am - Millersville, MD
well, the statistics on the surgery don't help your cause.  the insurance companies have finally starting approving lap band and rny because the center of excellence statistics have proven to them that they will pay less money in the long run for future medical needs if they pay for the surgery now.  the data on the VSG doesn't exactly show that.  i'm not criticizing your decision.  you've mentioned why lap band and rny are not options for you and i respect that, but there are clinical reasons why they are the leading surgeries for wls and why insurance companies have put their faith in them.  i understand your disdain for dumping, but the bowel problems that result from vsg are pretty ugly as well sometimes.  are you sure it's not an even enough trade for you to reconsider?
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