Federal Employee Program BC/BS covers VSG!!!

Thanks to folks from the VSG forum and the Oklahoma forum, I got enough information gathered (CPT and ICD-9 codes) to verify that the sleeve gastrectomy is covered by our insurance (Federal Employee Program BC / BS). I am so relieved!!!    I want to share the coding and necessary information here, so here it is! This is from an email from an authorization specialist from the Cleveland Clinic Florida. the icd9 is 278.01 the cpts are 43843 43659 yes the federal employees plan covers the sleeve gastrectomy I have had several approved as long as you meet criteria  bmi of 40 or 35 or over with 2 co morbid conditions.

Good info. I have Empie BC and they also covered on the first submittal

Do you mind if I ask what date you had your surgery? Did you have a VSG? I know it's automatic for BMI > 40, or for those with BMI 35 or above with 2 co-morbid conditions. I'm in the process of gathering all the documentation on my co-morbid conditions. I've been talking to  FEP BC/BS almost daily lately. I'm trying diligently to get everything prepared so that my BMI of 37.7 will be sufficiently covered with the co-morbid conditions being demonstrated and very hard to have any medical treatment be sufficient by medication. Thanks for any additional information you would consider sharing. I'm so happy for you!!!   Shelly

Hi Harris, I wonder why some BCBS covers VSG and others don't....I'm happy for you...Hugs, Kathryn 

Federal Employee Program BCBS has always been very WLS friendly. I think they recognized early on that WLS saves them  money in the long run....rather than paying for so many meds and surgeries for heart conditions, diabetes, high blood pressure, and the higher incidence of cancer among the obese population. They have recognized VSG since 1-1-08 and I think they are jut one of the insurance companies leading the pack in recognizing this as an effective WLS, rather than still considering it experimental. I think they may have also recognized that it is less expensive than RNY. I just think they are ahead of the other insurance companies in recognizing the cost saving benefits of WLS, and health benefits for those they insure.