Gastric Sleeve and Horizon BC. Any other ins cover VSG?

I don't know the CPT (procedure code) for the Vertical Gastric Sleeve, so my insurance won't tell me if it is covered. But I have a feeling they don't, at least as a stand alone procedure. Since I'm in cobra anyway, I was wondering if anyone was able to purchase an individual plan that covers VSG (NOT VBG!) or heard of any group insurance that does? Thanks, Kahlua

Hi First, the procedure code that most use for vsg is 43843.  But when I called my insurance company, they told me that procedure code is covered, and after I submitted all my paperwork, it got denied on the basis it was "experimental".  I think the problem is that there really isn't a specific code for VSG yet, it falls under the description: Gastric restrictive procedure  without gastric                      bypass, for morbid obesity; other than vertical-banded                      gastroplasty I am currently appealing my insurance company's decision.  In doing the research to send with the appeal, I compiled this list from the VSG board. Cigna PPO Messa BCBS, MI Regence BS Anthem BCBS Medicare Aetna Aetna MCN UHC Pacificare UHC  BCBS, Mi HMSA BCBS UHC PPO Oxford I am not aware of all the details of the approvals, but here is the list. Good luck Martha

         

Dear Martha, Thank you for your response-- it was very helpful. I wish you luck in your appeal and hope you'll let us know the outcome.  Cheers, Kahlua

Trust me, if...NO---WHEN I get approved, you will hear me shouting it from the rooftops!   Martha

Getting approved with PacifiCare is a nightmare; 3 months into my approval process, they deny me because I've not completed their 6 month dietary program called "Healthy Roads" which is a telephone-based goal-setting diet plan with a dietician who is contracted with the insurance co.  It's pretty pointless. Plus, if you don't know about it ahead of time, and get a referral right away, then its an even longer fight. HOWEVER, they have approved the gastric sleeve. It's just a matter of GETTING to that point.