Hi all! Lurker coming out
Hey Everyone,
I've been reading on this site for about a month now. Lots of GREAT information! What a super source of support to have during the pre-op and post-op phases!!
I'm pursuing WLS through Park Nicollet Clinic. Not sure which procedure yet. Would LOVE to have the VSG done at the U of M, but my insurance (BCBS) covers this procedure only for people with a BMI > 50. I started out with a BMI of 41, but just this week dropped to below 40, so I doubt I will have an ice cube's chance in he!! of getting the VSG covered. So... my choices are the LapBand or RNY.
I know I will be posting LOTS of questions. Thank you to everyone here for sharing your experiences. That's the best way for others to learn!
Naomi
I've been reading on this site for about a month now. Lots of GREAT information! What a super source of support to have during the pre-op and post-op phases!!
I'm pursuing WLS through Park Nicollet Clinic. Not sure which procedure yet. Would LOVE to have the VSG done at the U of M, but my insurance (BCBS) covers this procedure only for people with a BMI > 50. I started out with a BMI of 41, but just this week dropped to below 40, so I doubt I will have an ice cube's chance in he!! of getting the VSG covered. So... my choices are the LapBand or RNY.
I know I will be posting LOTS of questions. Thank you to everyone here for sharing your experiences. That's the best way for others to learn!
Naomi
Welcome.
But PLEASE don't say never with BCBS because we've had "lightweight" (under 40 BMI) DS patients get approvals. So don't assume anything!
And NO, you don't just have the RNY & band as choices, you also have the DS and the VSG. Don't rule 'em out just because of insurance. I appealed BCBS and won my DS coverage, so it can be done...and my BMI was under 50.
I just want you to know that you STILL have choices to make. It's whether or not you want to fight for what you want or do you want to just settle on what's easiest for your insurance company? That's the real question here.
But PLEASE don't say never with BCBS because we've had "lightweight" (under 40 BMI) DS patients get approvals. So don't assume anything!
And NO, you don't just have the RNY & band as choices, you also have the DS and the VSG. Don't rule 'em out just because of insurance. I appealed BCBS and won my DS coverage, so it can be done...and my BMI was under 50.
I just want you to know that you STILL have choices to make. It's whether or not you want to fight for what you want or do you want to just settle on what's easiest for your insurance company? That's the real question here.
I'm with Diamond Girl . . . . decide what YOU want and fight like hell - you can always 'settle' after you've fought the good fight, if you have to. The DS has great studies behind it to use in insurance appeals, so don't sell it short. I realize the VSG is harder to appeal, since the studies aren't out here yet, but do what YOU want.
5' 5" - 317.5 / 132 / 134 SW / CW / GW
Thank you for the welcome!
I have an appointment with Dr. Buchwald next month, so I will see if he would support me if I decided to fight BCBS for the VSG.
DiamondGirl - I am very interested in chatting more with you. Can you share with me what approach you used in your appeal against BCBS? And/or point me to others who have had successful appeals for the procedure they wanted? I spoke with Dr. Buchwald's nurse (Danette?) this week, and she was kind of discouraging about patients successfully appealing denials by BCBS. She said she's only seen BCBS reverse their decision once, and that the patient went through months of work appealing the denial and hired a lawyer to help with the process.
Naomi
I have an appointment with Dr. Buchwald next month, so I will see if he would support me if I decided to fight BCBS for the VSG.
DiamondGirl - I am very interested in chatting more with you. Can you share with me what approach you used in your appeal against BCBS? And/or point me to others who have had successful appeals for the procedure they wanted? I spoke with Dr. Buchwald's nurse (Danette?) this week, and she was kind of discouraging about patients successfully appealing denials by BCBS. She said she's only seen BCBS reverse their decision once, and that the patient went through months of work appealing the denial and hired a lawyer to help with the process.
Naomi
Hi Naomi! I'm glad you've made an appointment with Dr. Buchwald. I think you really should give the DS a lot of thought before giving up on it. Diamond Girl had BCBS, fought hard (and long), but won, so it's obviously doable. Check out the DS message board on OH for more information or dsfacts.com, that is one of the best places to get information on it. I think, and obviously Diamond Girl did too, that the DS is worth fighting for!
Congrats on the decision for WLS, though!
(current as of 12-10-09 -- surgery date: 12-16-08)
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