Insurance Road Block???/

Hi All,

Question.... My new insurance (BCBS of Mass) goes into effect on 6/1 and while our policy will have bariatric benefits, they have a policy bulletin that says they won't pay for a sleeve.  Does that mean they might decline to pay for a DS as well since a component of this procedure is a sleeve?

I plan on calling them after our policy goes into effect, but I'm going to be stressing in the meantime.

Thanks!

im not 100% sure but i think most bc/bs plans cover the ds. they dont do sleeve as a stand alone procedure but do do it as part of the ds or as part of the ds as a staged procedure. again,not completely sure but this has been what I seem to have read. good luck!

In just a few days you can call and get the straight dope.  My BCBS did not cover the sleeve as a stand alone until last year, yet my DS was covered in 2008.  It's all very individual and your insurance company is the only entity that can answer your questions.

Calm down and enjoy the nice weather and 3 day week-end.  Yeah, easier said than done when you're in the initial excitement over WLS, but try anyway.

The Sleeve and the DS have two different procedure codes. The sleeve is still considered experimental by some insurance companies, but the DS isn't. I don't think you have anything to worry about.

Thank you all for your responses.  Last night after posting this message, I kept digging around on the internet trying to find more info, and I found something that was actually from the Cleveland Clinic that had the actual bulletin and it says that DS is covered. 

I am excited and so looking forward to this adventure!

 Yes now I've hit an insurance block also. I'm thinking of trying to combine a reflux surgery to rid myself of this problem and see if a Dr might do a DS procedure at the same time. Is this a solution or not? Susan

I don't know if they can do both or not.  i heard someone else on another site say that her surgeon wasn't able to do it when she had her DS done or not.  But I don't remember if she was actually trying to have a fundoplication or if she might have had a hiatal herna, which is what I have.

I am hoping my doctor might be able to take care of both for me too, but won't know until early June.  My surgeon is already going to be a revision of a really old gastric stapling, so I don't know how that will all factor into the DS scenario.

 Where are you located? I'm in The DFW area and the only Dr recommended to do a DS is Dr Stewart.

I am in Indiana.  I am going to use Dr. Kemmeter in Michigan.  However someone I know is getting ready to use Dr. Stewart and she is super excited about it all.

 My insurance is BCBS of Mi, they covered all the cost of my D.S. They called it "Biliopancreatic Diversion with Duodenal Switch" . I called my surgeons business office to get the charge codes to be able to ask BCBS myself  if I was covered, and what requirements there were. There was no preapproval necessary for me they said.  Differences between policies may apply. Check yours. Call Dr. Kemmeters business office on Tues, they will give you the codes. Next I informed the office of my approval conditions, and asked to book my surgical date.

I really like GHP's total care from start to finish-5 star quality. I felt complete confidence all along the way. It relieved all stressI had when working with the first local surgeons office when I was starting to sign up for WLS. So pleased I changed to having the D.S. with Dr.Kemmeter.  If you have misgivings about the lack of individual attention you are receiving, how can you feel trust in their capabilities when your life is in their hands surgically, and with post surgical care? Everyone likes to think their doctors are the best, but until they have gone through it all they really dont know. My first gut feeling about GHP remains the same as my hind sight. It is the best place for such a major procedure. I really wish they could handle all aspects of my medical care, because their total care approach is so rare. They cant because their focus is on bariatric surgeries. I'm still trying to talk them into hiring PCP's  at their location for all their patients. 
They have a referral system of doctors familiar with the D.S. Dr. Kemmeter has been sending many of his D.S'ers to them. If you dont live close enough to take advantage of these doctors, he will communicate with your PCP and others for continuity of care. GHP really wants you to succeed with your overall health goals.