Insurance Coverage for VSG!!!

Thanks to folks from the VSG forum and this forum, I got enough information gathered (CPT and ICD-9 codes) to verify that the sleeve gastrectomy is covered by our insurance (Federal Employee Program BC / BS). I am so relieved!!! And, I think I'll be having surgery in Norman with the surgeons of OWLO since the hospital and surgeons are preferred providers and in-network on our insurance. I also attended their seminar last week and was pleased. I am scheduled to attend the WeightWise seminar on the 25th of this month, but just found out that neither the surgeons nor the hospital are in the preferred providers of our insurance. That would increase our cost substantially.     I want to share the coding and necessary information here, so here it is! This is from an email from an authorization specialist from the Cleveland Clinic Florida. the icd9 is 278.01 the cpts are 43843 43659 yes the federal employees plan covers the sleeve gastrectomy I have had several approved as long as you meet criteria  bmi of 40 or 35 or over with 2 co morbid conditions.

Shelly; Do the offer the VSG at OWLO? I went to their seminar back in July '07 and they only did the Lap Band and RNY - Maybe it's changed? - Anna

Anna, they do now offer VSG. I'm thrilled. They are in the very final stages of getting all the cost factors finished with the hospital. They did discuss it at the seminar last week and even more so when I stayed late to ask specifics after the seminar. Shelly

Shelly I had my nutritionist appointment on the 10th of this month at OWLO and asked her about the VSG and she told me it was  something they were looking into but she had no information on it.  She said she was not sure when they would be doing the VSG surgery.  Just wanted to let you know.  Glad to here that your insurance will cover it.  Good luck!! Heather

Thanks Heather. I talked with Dr. Nelson and the office manager at last week's seminar and they both said it is just in the final stages of being finalized at the hospital on the cost agreement. They were both very positive about it and it should all be finalized by the time I make it through all the prerequisites. I'm staying in touch with them about details. I'll keep everyone posted as things progress! Shelly

That is great!!  I wished my insurance would have covered that procedure it sounds like a good first step before a bypass.  I will keep you in my prayers. Heather

Thanks so very much, Heather! This will be my only procedure. I'm not a candidate for RNY or Lap Band since I have systemic lupus. But, the vertical sleeve gastrectomy will be perfect for me. I'm looking forward to getting all the ducks in a row and getting a date.  ; ) Have you had surgery yet? Which surgery have you had or are you planning to have? I'll be in prayer for you, too! Shelly

No I do not have a date yet they are in the process of submitting to insurance should know something in 5 to 6 weeks.  I am getting the RNY.  Keep in touch maybe we will run into each other at an appointment. Heather

Heather, that would be great! I'll let you know when I have an appt. time coming up. ; )  Shelly

Oh, I just noticed that the in the list of surgeries performed by Dr. Nelson on her OH page now lists VSG. You can see it HERE. I'm so excited!     Shelly