Not so good news..need your help

Wow what a day!  Today was my 10day/pre-op diet class.  I WAS scheduled Feb 24th for the vertical sleeve gastrectomy.  However my Doctor found out today that my insurance does NOT cover the sleeve and I need to choose another procedure.  Now I know that BCBS Federal has covered this before, but Dr Nelson found out that they covered them in error.  They told her where to find the documentation and she showed us the copy of it.  The policy is dated 11/08 and specifically states that the Vertical Sleeve Gastrectomy is still considered experimental, and they did not cover it.  She has had several patients that they did cover it for, but the Director of Medicine with BCBS told her that they would not cover it again.  The code that they used in the previous cases did not indicate specifically the VSG.  The code they have to use now does.  It's the pits huh?   So, what I would like is for you, based solely on your experience to either state your case either why you would recommend someone to choose RNY over the lap band or vice versa.  I have a very short suspense date to decide (I have to let Dr Nelson know tomorrow morning) and am doing research on my own, but I was hoping some of you could help.

Added:  Thought I would add a little here.  Dr. Nelson is not rushing me into a decision.  I want to keep my original surgery date of 2/24 because my daughter from Florida has airline reservations to be here with me the week of my surgery.  And we have plans to go to Florida in April, so I want to feel good by then.  Otherwise, I would take longer to make my decision.  Before I decided on the VSG, I did a lot of research on the different surgeries.  I appreciate all of the comments, and will talk to Dr. Nelson tomorrow.  I do have a lot of questions for her, and I know she cares for her patients.  I just did not want anyone to think she was the one rushing me to make the decision.

Thanks in advance
Marsha 

Gosh!  It is such a personal decision...I had the lap band on Jan 9, 2009 and really like it.  I've lost 19 lbs and have had no problems.  Can you talk it over with your dr?   Big decision.   Good Luck.  Let us know what you decide.

Me personally, I would choose the RNY over the lap band.  I need more of a tool to help me keep the weight off.  And if the RNY gave me more drastic side effects than the lap band, than that's what I would do.. But than again it's a personal decision..

Good luck, with whatever you decide..

Sheila

Marsha,

I have BCBS Texas Teacher's Retirement and I had RNY on December 22.  They have covered everything, except I had the six month waiting period.  I've lost 24 lbs. since surgery and 58 total.  I have had complications, but I'd do it again in a heartbeat. 

I think you probably need to discuss it more with your doctor and see which procedure is best for your situation.  I chose RNY because I am a sweet eater, and you're not suppose to be able to eat sweets.  I know some people can, however I can't, which is exactly what I wanted.  Sweets do not even appeal to me anymore.

Good luck,

Hugs,
Marsha

My insuarnce only covers RNy or lapband also. I chose the RNY because I wanted the restrictions that you have with the RNY. I am afraid I won't be successful with the lapband. I know they say you can eat around every WLS, but for me personally I think the Rny would be harder to do that with than the lap band. Lap band only restricts the amount of food you can eat, not what you can eat.
Emily

At the time I had my WLS, I know Tricare was not yet covering either VSG (VSG, it wasn't even around then that I know of) or lapband so that pretty much narrowed it down for me.  There was no doctor anywhere near here that did the DS and I had read many good things about Dr. Warnock and the RNY surgery over my years of researching.  I was psyched about the good things RNY would bring for me.  I have had my fair share of complications, but I would do it over in a heartbeat as well.  I've lost well over 160 lbs from my highest weight and 140 lbs from surgery date.  I have lost many co-morbidities and a lot of medications and I have also been blessed with my 2 babies that i would not have had if I had not had my WLS.  RNY has been wonderful and I cannot say enough good things about it!  I will be 5 years post-op in August and have been maintaining for about 4 years now, even after 2 pregnancies (I was at goal before the first one).

However...

WLS IS a personal decision and you have to do what is best for you.  All we can do is tell you our own experience as a testimonial and you have that to look at.  I know you'll make the right decision for you and I look forward to following your journey.  *hugs*

I agree it is a very personal decision.

You have to understand with RNY, you will be REQUIRED for the rest of your life to use supplements/vitamins.  It is rarely reversible and then only in extreme cases.  Think of it as permanent.

The lapband can help you accomplish the same thing, just takes little longer to loose all your weight than RNY.  But, it is reversable and you won't have malabsorbtion issues.

Even though I have also had some complications, it was the right choice for me.  I see my PCP alot more now, since I have had some low iron and potassium issues.  But it is workable.

It has cured my TypeII diabetes and that was a main factor for me going ahead with the surgery.  I talked it over with my PCP and my specialist before deciding for sure.

Best wishes on your journey.

I too have chosen the VSG, so I feel I can only tell you the reasons why I did not choose either one of the others.

RNY- the risks of leaks and ulcers seems to be higher.  It just stands to reason, the more connections that have to be made, the higher chance of leak.  Also, I know that I have to take anti-inflammitory meds now and that I'm sure I will more as I age, so that's a huge risk of ulcers there.

Lap-Band- at first this is what I was going for but after seeing pics of how the stomach can slip, all I could think about was how the waist of my pants roll everytime I bend over and I can see my tummy doing that within the first week of having the band.  I know, it's so lol!  But I also don't like the repeat visits for fills and I'm a self pay, so that's not good.

Anyway, I wish you the best in your decision and maybe just open the question up to God and you'll hear what He wants you to do.

Jen

do your reasearch , ask as many questions as you can and choose what is right for you , i dont say anything negative about any surgery choice , no matter what you are taking control of your life and making a decision to change it for the better .  I truly believe you can fail with any type of surgery if you are not willing to make the necessary changes , so please take time to read and ask questions to YOUR DOCTOR,,,, good luck 

Wow-that's tough and reminds me why I hate insurance companies.

I am very happy with my lap band.  I've lost over 100 pounds.

I think any surgery can be "eaten around" but all the eating requirements for the surgeries are very similar, so if your head is in the right place, I think you'd do well with any of them.  The band and the VSG are similar in that they are both restrictive procedures, no malabsorption.  The adjustable feature of the band is a pro and a con.  Pro if you need an unfill for some reason, con if you are having trouble reaching restriction.

Good luck on making a decision, and it could be worse-at least your insurance will cover something....