Frustrated...2nd denial

I know many of you have gone throught this.
I am about to do my 2nd appeal with Blue Cross (IBX).  They denied
my VSG twice.
My BMI is 42, I have Lupus, HBP, Fibromyalgia.

Any ideas for this new appeal.  Have all my doc's write supportive letters?
My surgeon would rather I have the VSG due to the Lupus, but would not
rule out RNY.  I almost feel like giving up and going for the RNY, but isn't that what the insurance companies want us to do?  give up...

any support, ideas, etc are much appreciated...this has been over a year of working on
this...

thanks!

Wow, I am sorry to hear that. I don't have any personal advice for you. Have you checked out the VSG forum here in case anyone else had the same issues?

Also, is there a person at your surgeons office that can assist you. I know when I was waiting on approval, the lady taking care of it assured me if I got denied, she would help me do what I needed to appeal. I didn't need to appeal but I felt good knowing she offered it if I did need it.

Good luck to you. I hope you get through this hurdle.

I'm wondering if the VSG is specifically a denial clause in your insurance policy?  Just a thought.

I don't have any other advice, although I like Jo's suggestion of going to the specific forum to see if they have any advice for you.

I'll be thinking of you.

Pam

I had my OBGYN, my asthma doc, my family doc, and my nutristionist all write letters... my ob because of pcos... my asthma because we thought that weight loss would make my huge boobs smaller to help with breathing besides the other weight loss (the boobs part never happened lol... he is going to write a letter for when I want boobies smaller surgery lol), my family doc because he was my PCP... and my nut because I worked with her for 3 years and no weight loss... all of those helped me... so asking for letters from all of them won't hurt... esp from the surgeon explaining why VSG over RNY... that might help...

thanks for your help!!!

I have IBX as well and was approved the first go round (actually with in 24 hours) for RNY and my BMI was 42.2.

My guess is that the VSG is excluded? Did they send you a letter of denial? What did it say? If not I'd get on the line with them and ask the pre-cert department what the reason was.

Good luck, keep on trucking!

The denial is calling the VSG investigational.  Although when i first called way back when, the pre-cert dept told me, it was a covered benefit, but needed pre-certification.  I cant have the Lap Band as it is made of silicone and contraindicated for those with Lupus and the RNY is riskier than the VSG, the reason my doc chose it.  So I will keep fighting ...I am not 100% apposed to RNY, but I want the safest surgery for my situation.

Thanks again!