How the hell did everyone get VSG approved?

WLS is a 'bronze plan basic coverage requirement" under PPACA (Obamacare) now.  That doesn't mean it's affordable or that the medical coverage determination isn't a first class pain in the butt, but it is a covered benefit. 

When I decided I wanted to move forward I went out and put my hands on the health plan's Medical Coverage Policy / Benefit Statement.  It specifically lines out the rules for medical determination for the various procedures.  From that point it was just a matter of discussing with my PCP what I needed to do to meet the requirements.  Took less than a couple of weeks and I was approved.  If you can hand the UM nurses everything they need on the first call from the doc, it usually goes much more smoothly. 

Wow!  Thank you so much for your reply.  I'm even more intrigued now.   

Best to you!!

Yes, many insurance companies just added it as a WLS they approved in the last couple years or so, or even more recent for some companies. Recent research shows that it is a very effective option.  I was approved on the first go, and it is actually a pretty common surgery now where I got mine.

You were ahead of the curve.  Here in Michigan I saw a report the summer of 2011 saying Vsg just went mainstream for the insurance (and then I pursued having it done.)  If you are still in need of surgery, you likely will not have an issue if your insurance covers it assuming you meet the criteria.  Criteria for my plan was a bmi > 40 or >35 with 2 comorbidities.  I was very blessed- for less than $500 I got my life back, and am absolutely convinced that my insurance company will save the invested money 10 times over.  

I work in the healthcare industry and Medicare just modified their requirements in 2012. They reduced the bmi and eased up on the comorbitities. Most insurance companies tend to follow Medicare guidelines eventually. Now's a time to look into it again. Most insurance companies publish their medical policy online so you may be able to see if they cover it and under what cir****tances. Good luck!

I was denied by Aetna in early 2010, but approved for the RNY.  I went thru the RNY surgeon's pre-op program, all the while wanting a VSG.  I finally decided about a month before my RNY surgery date to go to Mexico and get the VSG, and set it all up, paid, etc.  Then (of course) I got a letter from Aetna that the VSG was approved.  By then I had decided Dr. Aceves was the guy for me, so decided not to unravel all my Mexico preparations and just went ahead, mainly because in the U.S. at the time so many insurance companies were denying VSG, that U.S. surgeons (including the one I would have gone to) didn't have the experience under their belt that Aceves had.  Not true for all, of course, but certainly for the one I would have used.  And not so true today, thankfully.

Here is a link that talks about the ASMBS position statements that VSG is no longer investigational:

http://asmbs.org/resources/documents/position-statements/405-7sleeve-gastrectomy-as-a-bariatric-procedure-update

Laurie

I think it was probably just timing, my insurance didn't cover VSG in 2009 but did cover other types of WLS.

The surgery was considered medically necessary for me so insurance covered it and my choice of surgery was VSG with all supporting documents I was approved in 3 days....but again, I am sure I would have been denied if I had applied for VSG in 2009.

I have good insurance blue cross blue shield and it was relatively easy to get approved. Good luck hopefully you get approved this round. I recommend it for anyone and everyone. Everyone should only eat 1/2 cup to 1 cup meals. It would save on so many health problems in my opinion. However I've lost 75 pounds in 5 months so maybe I'm biased.

I was banded in 09 as my insurance wouldn't cover the sleeve.  They just started in 2012.  With all the problems and cost of the band, they figured out it is cheaper.  They 6 year study also came out with results similar to RNY.  (Not that they haven't had results for years, many would get the sleeve and not go back for the DS switch.  It was also used for cancer and ulcers.)