BCBSM and the sleeve coverage...

I'm just confused, I'm getting a different story than my gf... 

So I called Dr. Verseman's office and asked what codes they use for VSG and they gave me 278.01 for morbid obesity and then CPT code of 43843 so I called my insurance and it's covered as long as I follow the guidelines.

So I gave my gf the same codes, she is going to Dr. Verseman too and when she asked about VSG, they (Dr. Verseman's office) told her that BCBS doesn't cover it....  so she called her insurance today and gave the codes of what I gave above and the lady from BCBS told her that the codes are 278.01 and the other code is 43999... and that it's not covered unless you have a BMI of 50 or greater...

I have BCBSM PPO Flexible Blue and she has BCBSM PPO Community Blue....  but still...

any help would be appreciated... thank you!

Last I knew, they didn't cover it unless you have a BMI of 50 or higher (thats how I got them to pay for mine). 

You have to keep in mind that your employer's specific plan includes different things, so there is a chance that your plan is very different from hers when it comes to this.  Just call the insurance company again, and just try to talk to someone without procedure codes, because sometimes the procedure codes are different anyways.  If you get someone nice enough and helpful enough, they will be able to guide you. 

We all have different insurance, so its hard to give advice.  Just keep calling until you get firm answers.  They are the only people that really know.

Hi,

I am new to this forum as of today. I also have BCBS Community Blue PPO...I have colitis, but I also have a BMI greater that 50. I called BCBS today to see if certain procedures would be covered...gastric banding is...but I am told that I can not have this since I have colitis (in remission for 10 years)...the 1st surgeon I consulted indicated my only hope was VSG....but I was told today that VSG is considered investigational if it will be my only bariatric surgery. I have a consult on Tuesday with a new surgeon in Livonia...has anyone had a similar experience? Does anyone know why the gastic band is prohibited for me? Is there a way to get VSG approved?

Thanks so much for your insights!

I have BCBS PPO and I was recently approved for the VSG.  My surgery date is 2/10/09 with Dr. Foote in Grand Rapids.  It seems the VSG has not been approved in the past, but I believe the insurance companies are starting to see good results from it and are approving more of them.  Best of luck on your WLS journey.