Premera Blue Cross AlaskaCare Retiree & Vertical Gastrectomy
I have been lurking for almost a month now, and have learned so much from all the forums and links here. Thank you all so much for posting and answering questions.
Has anyone tried to get the Vertical Gastrectomy (vertical sleeve gastrectomy) covered by Premera Blue Cross AlaskaCare retiree insurance? I will call them on Tuesday, but wondered if anyone here has tried.
This is what their plan book says about WLS:
Gastric bypass surgery and vertical banded gastroplasty surgery are considered
medically necessary and appropriate when the following criteria are met:
the patient is twice or 100 pounds over ideal body weight, as determined by
the claims administrator;
there is a documented history of recent (past 6 to 12 months) attempts to
lose weight through physician-supervised, nonsurgical means; and
there are no contraindication to surgery.
Noncovered services include, but are not limited to, intestinal bypass surgery,
loop gastric bypass, gastroplasty (stomach stapling), duodenal switch operation,
biliopancreatic bypass, mini-gastric bypass, gastric bubble balloon surgery,
special diet supplements . . . So I am wondering if "gastric bypass surgery" includes vertical gastrectomy, seems
like it ought to!
Thanks in advance for any opinions.
After posting this it occured to me that those in the VGS forum might be better able to find this question and respond, so if you are interested in the responses I received and the information I have discovered see this thread:
http://www.obesityhelp.com/forums/VSG/a,messageboard/action,replies/board_id,5463/cat_id,5063/topic_id,3305039/http://www.obesityhelp.com/forums/VSG/a,messageboard/action,replies/board_id,5463/cat_id,5063/topic_id,3305039/v