Insurance says VGS is "experimental" - I am so sad :(

Do they cover DS? If they do, just sign up for that and get the VSG part and don't go back for the DS half.

I'm not sure. I know they cover other bariatric surgeries and she did mention RNY before I cut her off and got off the phone. I was upset :-/

I had no idea that you could get a switch but not get the whole thing....

Breezy25...Don't feel bad, let me tell you what BCBS did to me. I needed to have an endoscopy per my surgeons requirements. So I had the procedure done. The insurance paid the surgeon, all of the hospital fees and even the doctor who had to read my biopsy. However, they DENIED the procedure itself and the cost of the anesteologist. Why did they deny it? They said the endoscopy "IS EXPERIMENTAL AND NOT ACCEPTED BY THE MEDICAL COMMUNITY." What the heck? The hospital said they would get my medical records and appeal the decision. If not, I will owe almost 7000. I am furious. It makes no sense to me. 

That is such a slimeball thing to do to someone! I'm sure you wouldn't have gotten it had they told you that before hand!

Yes, the DS is usually two procedures, the VSG and the actual duodenum procedure. They can code it DS with no diversion, I THINK. There used to be a vet on here that did it this way. If they cover DS, you are in the clear, I would think.

Sure, they could do it that way. The surgeon would only be breaking a few laws and some ethics violations. I think it will be hard to find a doctor willing to risk their license.

I would go ahead and appeal because I believe it was in 2013 medicare approved the VSG as a covered surgery and that is usually the standard the other insurance companies go by. Once they approved it as a viable surgery the rest followed suite. I think the person you spoke with may bot have had full information regarding the newer approvals of the VSG. Don't just settle go for what you want!

Hey, six years ago blue cross told me this. i appealed to the california department of insurance and won. go to my blog page on this site and look at the post  4 months out. it contains a copy of my appeal letter.  a lot has changed in 6 years. the ASBS considers it not investigational. check your policy on appeal procedures and then do it.  lots of people won using my letter as a guide and Blue cross finally changed their policy. 

VSG is now very mainstream .   again, look in your policy and call your state department of insurance for appeal procedures.   it can be done.  gl.  diane

Thank you, Diane! I'm sorry if you have it posted somewhere but can you give me a link?

God that is old information that your insurance has.  Years ago they'd say this.  If you got approved for WLS by your insurance, then a VSG approval will be easy as pie.  

All best,

Layla