Officially Denied

I shouldn't be surprised, I did expect it but still disheartening.  BCBS of NC (State employee's plan) denied VSG because they consider it to be investigational. I have not gotten my Dear John letter yet but my surgeon's office called me. So I need your help.!! What do I put in the appeal letter? I have some research info from the internet but what do you think would be helpful? I have BCBS federal , MD, DC and Carefirst policies showing they do approve it. Should I get letters from my PCP, nut and/or psych?

I am cross refering this on the VSG, Main and Insurance boards.

Thanks a heap!!!!!

Obesity Action Coalition website has some great sample appeal letters.  And dont give up!  Are you totally decided on the VSG?  BCBS of NC are approving for Roux-En-Y right now.  My cousin is doing his 6 month doctor visits now, and he is going through Dr. Enochs!  Just something to think about!!  GOOD LUCK!!

Since the VSG is the first part of the DS - will your BCBS approve a DS? Mine does -so what if you have the DS done in two stages... but never get the second surgery??

We thought about that...but they won't cover DS in a two step procedure. It is absolutely rediculous. I sent my appeal in today and I am pretty pleased with my documentation and letter...hopefully they will be too! :)

 You should include the names/ policy number/ insurance of people who have been approved for the VSG.  Maybe you can post a thread asking whos been approved for VSG and PM them asking for their real names and insurance info.  Include medical studies and peer reviews if you can stating that the VSG is an effective stand alone WLS. Best of luck. PS like someone else said have you thought of getting the DS? It is not considered experimental or investigational by most insurance anymore and is covered by medi-cal/ medi-care. The DS offers malabsorption so you can maintain your weight loss long term. Just a thought

Yes my appeal included 7 significant studies and two BCBS policy copies showing they consider tVSG medically necessary.