Feds wanting VSG beware of SAMBA insurance

Well I finished my 6 months (actually did 7) of PCP supervised weightloss, completed all my pre-op testing, had a Oct. 16th date for the surgery and my surgeon submitted all my paperwork for precertification with SAMBA.  Now mind you I met all the requirements, even have a BMI over 50 with multiple co-morbities.  SAMBA had no specific WLS options excluded in their plan...however... the catch...SAMBA uses CIGNA not only for their network resources and costing review as I was told by SAMBA, but also for determining WLS precertification - so it was a CIGNA medical doctor that reviewed and dissaproved my precertification request!  I might as well have CIGNA insurance as far as I can tell.  If I appeal, then I will most likely miss my chance of changing insurers during the federal open season in November.  I guess I will just switch to fed BCBS in January and try with them.  My surgeon says she has had VSG approvals with BCBSfed.  Beware federal VSG wannabees - don't go the SAMBA insurance route this open season.  I don't have the particulars on my denial yet - but I suspect that what you see in their brouchure will not be what you get!

I researched all the federal plans last year when we switched.  I had Healthnet back in 07, and they paid for mine, but it was kind of a hassle.   So I researched plans, talked to surgeons offices, etc...and found that BCBS was the easiest choice.

Glad to hear that, I read on some earlier posts that even some that have fed BCBS had issues getting approval but my surgeons office said that is the only federal insurer that they have had any luck getting the VSG approved.  Sad that I have to wait, but I am sure it will be worth it.

We've been really happy with BCBS. I had no issues getting approved for my VSG!! 

Good news for sure,  when I spoke to the women who submits claims for my surgeon, she said BCBS was my only possibility for VSG approval.  I was surprised she also said they require a BMI of 50 or greater but I saw from your response and the one earlier, that that is not always true.  You just never know what to expect from the insurance providers.  I was led on by SAMBA and the wording in their policy - so I guess I will just have to wait a while longer.  I really can't wait to join all of you who have made it to the bench!

My BMI was below 40 and I only have one co-morbidity, at least that was documented. My cholesterol was pretty high and I knew it, but never saw the doc about getting meds for it, so it wasn't documented. I sure hope it's easy for you to get approved!!