Just Denied

I'm so sorry. As many other posters said, try going at it from another angle, even if it takes a few months of documentation!

Just try to stay motivated and DON'T GIVE UP! You CAN still lose weight; don't feel like you "failed" and it's over.

I'm sorry. Appealing is a good idea.

Would revision to RNY instead of DS have a better chance of approval?

I raised the idea of a RNY, but the insurance point person at my surgeon's office said they would consider that a second surgery. Evidently they are saying one WLS per lifetime. Can you imagine if they said that about heart patients?!?!

Do you have any malfunction with your VSG?

Not that I know of ...

I wonder if that has something to do with the denial. Like if you had an issue causing you to need a revision for medical reasons they might be more willing to approve surgery. Regardless, I hope the appeal is successful.

Insurance and medicine in general considers bariatric surgery an elective procedure, so it's not medically necessary in all cases by their standards. You won't necessarily die without it unless you are of a significantly higher weight. Heart surgery is considered essential because typically you will always die without it. Being obese is unhealthy, but many people live quite a long time with varying degrees of obesity.

Don't get me wrong - I think for longevity and quality of life it's vital for many of us. Sadly, that's the medical perspective, though.

Have you yourself called your insurance company to see what your plan covers? Don't rely on the surgeon's office to give you information as all insurance plans are different.

If it is true though that your plan only offers a onetime WLS then unless your surgeon can prove there is a malfunction or health issue with your sleeve all the appeals in the world will do nothing to change the denial. Even if there is a mechanical/malfunction there is still only a very slim chance the insurance will reverse the denial. You may want to look at self-pay options.

Good luck to you Babette. Stay here and stay positive, something will give.

I hope you're right, Happiness. I trust my surgeon she's tactful AND assertive, pretty hard combination to beat.