Going for 3rd appeal (IMR review)

 The battle with insurance companies are very exhausting and going on the third one... I just feel discouraged and all. I don't know what to do after this because I feel like I've exhausted my options besides self pay. I have been overweight my whole life, it prevents me from a lot of things that I can be doing at a healthier weight. I have no comobidities but still... Seriously... I only switched to blue shield because I wanted the lap band then I wanted the vsg and they wouldnt pass that for me. This is pathetic to say the least. I feel so pissed at blue shield. I'm glad lots of people are requesting it though.

Sorry to see you fighting the dumbass insurance companies sweety. I have MD-IPA and I was denied for VSG 2 times and I found out that they quit ok'ing them 6 months prior. They say it is investigational. I felt the same way so I had to settle for the lap band which I am getting on the 11th of December so I guess i'll have to live with it. VSG first came out for people with a BMI of 50 or more and I am at 42 so they wouldn't do it anyway if they did honor it so not to be discouraging you might have to settle for the lap band like me. Believe me I didn't want it either i wanted VSG. Good luck sweetheart. keep us posted.

 Since you live in the state of CA, which btw you're very fortunate,  once you've exhausted all your internal appeals through your insurance company you can get an IMR (independent medical review) with the DMHC (Dept of Managaed Health Care). The DMHC is very pro WLS and in most instances will overturn insurance denials. You can ask for an IMR if your insurance denies you based on medical necessity or your insurance says the procedure you want is experiemental or investigational. Why is your insurance denying you? I know that they overturned denials for lap band but am not sure about the VSG. When you do get an IMR with the DMHC maybe you can cite cases where insurance(s) have approved the VSG and maybe they will approve it for you. Call up the DMHC and see what they say. There is someone there 24/7 and they are very helpful. Best of luck. Neely

Well my surgeon's office turned a request in and it was denied, then I took a month to gather information and studies backing up my reason for having this surgery, sent that in and got denied. They say it's investigational and experimental, I attached a 5 year study on it... It's frustrating how they throw the lap band and gastric bypass at you and deny the sleeve. I have heard I am lucky to have the IMR because others states dont have that. However, it is just exhausting... And I get it but it doesnt mean it isnt hard on me. I will look into the other ways I can fight my insurance, however, I hope they approve and overturn it this time.

 Well as someone who's fought their insurance for 6 years I hear ya about it being frustrating. But don't give up. Insurance is in it to make money and they just want to make you go away. If you get approved for the VSG it will only help those who come after you. Weird how some insurance is approving VSG and others aren't. Best of luck.

Sorry for your frustration. I too am fighting BCBS for the VSG. I just submitted my first appeal. Have you talked to any of the folks that have had their denials overturned by BCBS and what they submitted that worked? I am sure you have if you are going into your 3rd appeal. Good Luck to you. Let me know how it all turns out. The good news is with more BCBS picking it up and new procedures coming on board, they are more likely going to have more BCBS adding the vsg along with RNY and lapband.