Priority Health APPROVED VSG

MelindaR
on 11/2/07 2:56 am - Lansing, MI

I wanted to share this news with everyone and those searching to see if Priority Health would approve a VSG. MMPC (surgeon's office) faxed in all my paperwork last Friday and yesterday I got word I was APPROVED. Now PH covers the RNY, Lapband, and DS, however, before September specifically excluded the VSG. When I had my physical with MMPC, the dr. didn't think they would approve me for this procedure, however, told me to talk more indepth with my surgeon. When I talked to Dr. Foote he believed that they would approve me and they DID. PH has now changed their Bariatric Surgery policy somewhat. For those that have PH, I encourage you to go to their website and download their Obesity Medical Policy - No. 91435-R13. The wording they have added for the Sleeve is as follows: Sleeve gastrectomy is covered IF one of the following applies (Not covered for Medicaid, see #6 below): i. A Roux-en-Y gastric bypass is contraindicated (e.g. severe adhesions, previous bowel surgery) and the patient is either not desirous of or not a candidate for any other covered procedure (laparoscopically banded gastroplasty or biliopancreatic diversion with duodenal switch ), OR ii. The sleeve gastrectomy is an integral part of another planned covered procedure (i.e. duodenal switch procedure), but only if the sleeve gastrectomy is performed because intraoperative complications preclude the completion of the duodenal switch procedure itself. Now I have never had any bowel surgery, don't have adhesions, nor am I looking to have a two-stage DS. So what I'm saying is if you feel this surgery is the best option for you, and if your surgeon agrees, GO FOR IT!!!! You could get approved.