Insurance says VGS is "experimental" - I am so sad :(
So our new insurance doesn't take affect until December 1, but today I called and asked what the approval process was for VSG. She told me they cover bariatric surgery, but not VSG because it's "experimental".
I am really upset! I've been researching this surgery for a year now and I finally feel comfortable and like its the right surgery for me. I don't want a gastric bypass.
Has anyone run into this issue? Is there a workaround?
Ten or 15 years ago, most insurance companies wouldn't cover VSG because it didn't have a large track record. Most changed, both because it's now a proven surgery, and it costs them less than RNY. Apparently your insurance company didn't keep up with the times.
Canada still does mostly RNY, and you need special cir****tances to get a VSG.
6'3" tall, male.
Highest weight was 475. RNY on 08/21/12. Current weight: 198.
M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.
I call BS. Challenge it. You may be surprised by how they change their tune when challenged. VSG is no longer considered experimental and has a substantial research base to support its effectiveness. Get to work and inundate them with info and get your surgeon to write a letter that says VSG is a better surgery for your situation.
Good luck!
Wow, my insurance said that 6 years ago. So I decided to go out of the country to get what I wanted. Then about a month before my surgery they changed their policy - too late! I went ahead and had it done in Mexico. Never been happier.
Height 5' 7" High Wt 268 / Consult Wt 246 / Surgery Wt 241 / Goal Wt 150 / Happy place 135-137 / Current Wt 143
Tracker starts at consult weight
In maintenance since December 2011.
On a different note, as someone who wanted the sleeve and ended up with an RNY, it was still the best decision of my life. If ultimately the choice is RNY or nothing, I'd do it again in a heartbeat. Good luck.
Lanie; Age: 43; Surgery Date (VSG): 8/12/14 w/complications resulting in RNY next day;
Height: 5' 6" SW: 249 Comfort Zone: 135-140 CW: 138 (10/13/17)
M1: -25 lbs M2: -12 M3: -13 M4: -7 M5: -11 M6: -10 M7: -7 M8: -7 M9: -3 M10: -8 M11: -4 M12: -4
5K PR - 24:15 (4/23/16) First 10K - 53:30 (10/18/15)
No issues. Any discomfort in the beginning is long forgotten about now (kinda like having a baby) :)
Lanie; Age: 43; Surgery Date (VSG): 8/12/14 w/complications resulting in RNY next day;
Height: 5' 6" SW: 249 Comfort Zone: 135-140 CW: 138 (10/13/17)
M1: -25 lbs M2: -12 M3: -13 M4: -7 M5: -11 M6: -10 M7: -7 M8: -7 M9: -3 M10: -8 M11: -4 M12: -4
5K PR - 24:15 (4/23/16) First 10K - 53:30 (10/18/15)
I don't want to discourage you from appealing, following up, and seeking what you (and your surgeon) believe is the best medical option for you. Do it!
That said, if RNY is your only option, don't be scared of it. You should be more scared of the health consequences of being morbidly obese. THAT is some scary stuff, RNY not so much.
Does your surgeon have a support group where you can go meet people who have had the RNY and ask them about their results, any complications, etc.? I attend a mix RNY/sleeve support group, and the RNY people are always doing great. They look very healthy and happy to me. I also know several people who have had RNY (including my niece) with no complications or problems. I really want to encourage you to investigate and decide based on facts rather than fear and rumors. Good luck!
You know the crazy thing, it's BCBS. My SIL has the same insurance in another state and hers got approved no problem.
I'm wondering if there's some behind the scenes stuff that happens when the bariatric center calls the insurance company. I just can't believe it's not covered.
And yes, I think challenging it is a good idea. My husband seems to think the girl I spoke to didn't know what she was talking about. But she said she was reading it directly from the policy :/
