Insurance disappointment

I hope your dumping was few and far between and am glad there have been no regrets.  I just can't have negative enforcement in my life, especially with bariatric surgery. 

Was it VSG on the list, or VBG? VBG is an older, horrible surgery not seen much any more.

The first years VSG was around, a lot of insurance companies didn't cover it, since it didn't have much of a track record. It was either RNY, lapband, or nothing. Five years ago I wouldn't have been surprised to see VSG still included, but I thought yhey were over it by now.

If I'm not mistaken, I think Canada still covers only RNY, with a special waiver needed for VSG or DS.

The exact wording in the benefits book is sleeve gastrectomy, neither open or laparoscopic are covered.

I would ask your surgeon's office to call the insurance company to verify they don't cover VSG. When I read my insurance policies it said they only covered lap band and RNY. But when I went to my consult the insurance specialist assured me that they do VSGs with my insurance all the time. It turned out they hadn't updated the document in a couple of years.

Spoke directly to the insurance company today and no, they do not cover VSG at all under any cir****tances for the plan I purchased through the Market Place.  Neither do a couple of other insurance companies I found through the Market Place that I can afford. RNY and DS are covered but not VSG.  Go figure.  So now I am looking into financing surgery in Mexico.  The quotes I got for Mexico would put my payments right around the amount I would have been paying as a monthly premium to BCBSAZ.  So I switched to a MUCH cheaper insurance plan and will start saving $ and finance the rest for TJ, Mexico. 

I'm glad you got the info you needed (I'm sorry it wasn't the answer you were hoping for, though), but I am surprised that they will approve DS but not VSG. Screwy.

It sounds like you have a good plan in place to move forward, though!

Lora

Honestly, I'd have submitted for the VSG and appealed. And I would NOT go to TJ! Be certain you research your surgeon VERY well. This is not something you want done by the lowest bidder.

Can't appeal something they say they will not cover under any cir****tances.  I'm looking into A Lighter Me because they seem to have a decent reputation. Medical tourism is HUGE in Mexico and the hospitals that support it are very good.  There are a lot of people here in AZ that travel to Mexico often for quality medical and dental work.

VSG - although very streamline today, is the newest of stand-alone procedures, derived from a 2-part DS, where the patient was sleeved for a year or 100lb loss, then came back in for the switch part.  That may be why the VSG is not being considered with this insurance (the DS has been around since 1988 with strongest success statistics, so despite the complexity, it has respect).  Many patients with considerable health risks still do this, but most of us get the full DS at once.  

One way you may get sleeved is to have the surgeon seek approval for a 2-part DS.  Get your sleeve and you're in.  If your results aren't what you hoped for, you'll be pre-approved for the DS if you decide to finish the job.

That may be an option to discuss with the surgeon when I see her next month.  I have less than 100 pounds to lose so that may be a sticking point for the insurance company.