Has UHC paid for your VSG

Hi everyone, I'm in the process of trying to get UHC to pay for my VSG.  To my understating my policy pays for WLS surgery without any exclusions.  Sounds great right?  Exept for the fact that I'm being told that they look at VSG as experimental, so that they probably won't cover it.  I'm going to go ahead and schedule my surgery as self pay, but meanwhile I'm going to roll the dice and send in for predetermination.  I'm sure I'll have to go thru the appeals process, I just want to be ready.  So, I figured it would help knowing who out there has been approved. 

I don't know who out there agrees, but it seems like a bunch of bull that UHC will pay for some people and not others.  I know sometimes it depends on *****veiws the info, but that's really not fare.  If  as a company you feel its experimental than everyone should be denied.  Picking and choosing to approve some people isn't fair.   So, let me know if you've been approved and what did you have to do to get approved.  Did you self pay and then get reinbursed?  Did you get approved on your first try or did you go thru the appeals process?   

Thanks so much for any insight you may be able to pass on.  I greatly appreciate it, and I'm sure it will come in handy during my appeal process. 

Would love the answer to this one also!  My surgeon sent in my paperwork a month ago, after a week UHC said that they needed a 5 year history of MO.  I got that turned in a week later, and now it's been 2 weeks and I still have no answer.  I am hopeful because my predetermination status is still "pending", but I am anxiously biting my nails for an approval.  I think if I wanted RNY it would have gone through right away, but I am holding out for the VSG.  Here's to good luck for both of us!

Hi Aimes, Pop on over to the  VSG board (Banana Boat) and inquire about folkes with UHC getting it covered and see if you can determine what where the details of their cases that prompted approval and denial. Do you have any medical problems that would deem other surgeries inappropriate? Do you have any gut problems, or family history of Crohns Dis, Ulcerative Colitis, Inflamatory Bowel Disease? These issues would usually exclude you (or at least your surgeon could make that arguement) from an RNY. Also check out VSGFAQ.com for some other reasons why this surgery may be the most (or only) appropriate one for you. Also, if you need to stay on meds that have asprin, tylenol, advil in them, then the VSG is the preferred procedure for that, as you can take those meds--usually. Ask your surgeon to help you understand if there's anything in your medical history or meds list that would help make the arguement. Make sure that when you write the insurance comp you mention that you are aware of this procedure being approved for other UHC patients. If you have to appeal, you are right, you can call them on their decision being arbitrary. There might be some good news on the horizon. In late October, more research will be presented at a professional bariatric conference.I think it's either the American Society of Bariatric Surgeons, Association of American Surgeons, or SAGES (forget what that stands for). Anyho, I think the VSG docs will br presenting more research and really trying to push for the acceptance of the Sleeve (as a stand-alone preocudure, not just part of the 2 part DS)as safe and effective--therefore, not experimental-- with in the bariatric community. They may even be trying to discuss replacing the RNY with the Sleeve as the gold standard due to the fact that there are so few complications with the Sleeve, it is so much safer and better for the body, and is showing to offer comprable weight loss to the RNY. But that could be a rumor. Your surgeon should know. I think Dr. Gagner and Dr. Polk at Cornell Medical Center (AKA NY Presbyterian) are spear heading this effort. You could call them (212-746-5294). Now, that doesn't mean that insurances will automatically start paying for it (although more and more have been). But it is good amunition to appeal to the insurance with. Acceptance in the Bariatric community means a lot with the insurance, especially since it costs so much less $$ for the Sleeve. Good luck, Kahlua

Thanks so much for your email.  I haven't even though about having my doctor submit pwk on my medical history that would rule out RNY for me.  My father has Chron's disease, bad.  He had to have parts of his intestines removed because of the disease.  I also take advil, and from time to time have to take anit inflamatories, due to a neck injury that flares up.  I'm going to give my doctors office a call.  Thanks!