Federal BCBS, DS & Bayview- HELP!

 OK.  Things are so freaking sucky right now.  I left my first bariatric program after realizing the surgeon was lying to me (about surgery options, insurance, medical conditions, test results, ect), and after a denial.  I got denied for VSG, because according to Federal BCBS, I do not meet their criteria for that procedure as they only do that on persons with a BMI greater than 50.  After a failed appeal, which came back denied stating the procedure is "experimental", I tossed in the towel and took some time to regroup.  This first office took my program fee and refuses to refund any of it.  Unethical, shady and ****ty- yes, yes and yes.  Im considering legal action.  Lets not get into a ******g war or calling me an idiot over this- I get it.

I went to ANOTHER bariatric program.  Met with a very reputable surgeon.  He recommended the DS.  I agree with this recommendation.  Now the issue...  While he IS a preferred GENERAL surgeon with Federal BCBS, he has opted OUT as a participating provider for bariatric surgery.  This means, I would have to pay out of pocket for the surgeons fees- which are about $18,000.  My insurance would NOT repay me for any of that...  This just isnt an option for me.  I dont work, and cant.  Dont have credit cards and cant/wont get a loan.  Again, no judgements or wars please.

So, now, Im looking into Bayview.  Does anyone have any experience with them, and Federal BCBS BASIC?  Do you know if the Drs there are preferred, in-network providers?  Do they do the DS?  Is there a program fee?  

Also- what do you think the likelihood is of me getting approved for a DS with a BMI under 40, after just being denied for the VSG and NOT knowing what the cracker-jack first surgeon sent in to the insurance company as far as my co-morbids and letter of necessity and such?  Im thinking she didnt include in there that I have high cholesterol, borderline high blood pressure, "mild" sleep apnea, thyroid disorders and other things I recently found out she LIED to ME about and told me were FINE.  ARGH!

Can anyone help me navigate this please?  My head is freaking spinning and I am so down, confused and frustrated.  Im just not sure what to do, who to call, and what to ask.  Ive been around and around with the insurance company a million times, and they just talk me in circles with conflicting info.  Ive been on their website and printed everything I can get my hands on.  I will travel, meet for coffee, ect with anyone willing to help me get all this straight so I can go in prepared to be successful this time.

Hi there, if you're serious about looking into the DS I would strongly recommend posting this on the DS board if you haven't already done so. They have some real legal/insurance pros over there that can assist you.  Diana Cox in particular is who comes to mind.

Also, to the best of my knowledge, no one at Bayview currently does the DS.  Schweitzer used to and then backed out and ruffled some feathers and did some 'hybrid' stuff along the way.    I think I've heard that Vanguri (not sure who he's affiliated with) is getting into the DS but I would not go near him.  Greenbaum I think is in NJ and he's got a great reputation.

Best wishes.

I agree with Angie for a true DS you need to go out of state.

I think Jilly has BC/BS but I think it's standard.  She was at bayview....we have BC/BS standard but we had RNY at ST. Agnes.

dr. schweitzer does ds in two steps, the first being vsg, which is what you wanted originally then he may do the switch part after a year if you need it. may be a good bet and i know they are a center of excellance. that is where i went.

they have learned that doing the DS that way is not optimum.  

Truly if I was going to have DS I would go out of state to Jersey.