Any hope if specifically excluded?????

I am wondering if someone has been through a similar experience.  I have Priority Health HMO.  They state that they do cover RNY, Lap Band, and DS.  The thing is I have been looking into the VSG and it states the vertical sleeve is excluded.  Has anyone gotten their insurance to overturn the policy or am I stuck with the three choices they give?  Don't get me wrong, I'm happy my policy does allow for WLS.  I am extremely concerned with the malasorption part of RNY and DS and I know the Lap Band isn't for me at 300+.  Plus, with RNY I would be limited on the type of pain killers I take.  Since only Advil works (Tylenol doesn't touch my pain) I'm not even sure if DS is an option.  The fast it is the most extreme of the surgeries also concerns me. Gary any thoughts????

you should speak with your employer about a rider perhaps.  Other then that it could be tough to get it overturned.  You should argue that they allow the surgery, and cannot tell you or your doc what type to have and why this one is better for you medically

Okay, I know this thread is old, but I just came across it..... I am going through the exact same thing.  I did my due dilligence (sp?) and decided with my dr that vsg is best for me, and basically for the same reasons.  My bloodwork shows I have anemia, so that is one plus for the vsg rationale.  I am getting ready for appeal, and I don't know how successful I am going to be.  I just don't know what I will do if I get denied....pick another surgery (don't really want any of the other options) or put off surgery until it isn't considered "experimental", which is putting my health in continued jeopardy! VSGFAQ.com has some research links and a sample appeal letter.  pm me if you want and we can put our heads together Martha

Hi Martha, I'm in the beginning process of WLS and have my orientation this next Monday.  I'm not even sure my surgeon does the VSG, but will be finding out soon.  I'm in the same quandry as you are...do I go with RNY if VSG is denied or wait?  IF my dr. does the VSG then I'm guessing we'll try to put it through and see what happens.  If he doesn't, then I would have to start again with a new surgeon or again wait.  I'm currently at 350 lbs and I'm only 5' 1.5".  I have lost 25 lbs, so that's helped a lot, but I have so much to lose to get to a healthy body weight.  I do have the appeal information on the VSGFAQ.com site in case I need to use it. I will let you know how it goes next week.  At that time I will find out what my dr. specializes in and see if it's for me.   My DB (soon to be my darling fiance) has BC/BS of Michigan and when we marry I would take his insurance.  So, that is also a possibility.  Of course, we won't be getting married this year and if we do next year it would probably be at the end of the year.  The other option is a new job, but the market in Michigan is extremely bad right now. As you can tell I'm looking at all the angles.  I am currently researching RNY (just started today), to see if it is even a possibility for me.   Lots of luck Martha and I'll stay in touch.  What insurance do you have?  Mine is Priority Health and I've been cautioned by my PCP and her nurse that they are difficult to deal with regarding WLS.

Did you look for your surgeon here?  They have a chart of how many of each different type of procedure they have done. I don't think they are updated regularly, but at least you can get an idea.  I am in Michigan, too, (Southwest) so I understand about the job market.  I am not working now, and was hoping to get the surgery soon so I would not have to take time off right away if I got a job. I have UHC/Definity Health through my husband's employer. The insurance, in general, is great, except for this vsg!  Let's keep in touch Martha PM me if you want my email.