I am here to beg for help!!
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I have been non-existant on the boards this year. I was all set to have my DS with Dr. Crookes this spring when my insurance denied the proceedure. After 3 appeals, more health issues and a lot of stress I made peace with the change to having Lap Band done instead. I redid EVERYTHING; found a new surgeon (long story, nothing bad with Crookes) six month diet, lab work, EKG, ect ect for the pre operative work. Was all set two weeks ago to resubmit for my approval.
Today I got a call from my surgeons office telling me that Lap Band wasn't covered under my benefits. This can't be right, I had a LONG conversation with my insurance rep about which procedures were and were not covered and I was assured that "the band" WAS covered along with RNY. (I am not a very good canidate for RNY due to family hx of gastric cancer and my own polyps that they need to keep an eye one...therefore, I have to be able to be scoped)
I called my insurance company again today and I come to learn that the person I spoke with before was basically an idiot. When she referred to "the band" as being covered I assumed she meant LapBand. Nope, what she meant to say was that the vertical banded gastroplasty was covered. In the passed 18-20 months of researching weight reduction surgery I had not even come across this proceedure. For those of you that are as unlightened as I was, here is a link explaining the proceedure: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19498.htm
So, I am highly doubting that there is a surgeon out there still making this an option to their patients. Isn't this the dreaded "stomach stapeling" from the 80's that got so much bad press? Why would someone choose this proceedure over RNY, DS, LapBand or a sleeve? Why would an insurance company STILL cover this?
As my husbands policy is a self funded plan I need to contact his HR dept for any and all appeals. The insurance won't do anything because they are just going along with the benefit package the employer bought. The last time we did this we didn't focus on the VBG at all but now I need to see if there is anything we can do to get this procedure off the benefit plan and replace it with something safer and more effective.
Does anyone out there have any info on the VBG that can help me? Can anyone tell me if there is even a surgeon in the US that will still perform this?
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Please note that I WILL NOT go through with a VBG regardless if I find some one that does it. I just want to show the HR department that they are offering an much less safe or effective proceedure. So much so, that I can't even find a doctor that would perform it if I wanted it in the first place. (So far the only response I received was that there was a dr in CT that still did this)
on 12/3/08 3:01 am - sunny, CA
Vertical Gastric Banding (VBG) (Lap)
VBG uses mechanical restriction to cause weight loss, a similar mechanism to that used in LAGB, with no malabsorption component. However, the upper part of the stomach is stapled, creating a narrow gastric inlet or pouch that remains connected with the remainder of the stomach. In addition, a non-adjustable band is placed around this new inlet in an attempt to prevent future enlargement of the stoma (opening). As a result, patients experience a sense of fullness after eating small meals. Weight loss from this procedure results entirely from eating less. VBG was one of the more common surgical procedures for weight loss in the late 1980s and early 1990s but has been largely supplanted by LAGB since 1995. Now its role in the treatment of patients with severe obesity is limited. The open version of VBG is essentially no longer performed.
VBG - open and laparoscopic
Three commenters spoke to VBG. Two supported laparoscopic VBG referring to one paper, and one commenter reported having abandoned laparoscopic VBG for BPD/DS. We repeated our review of the literature and again find that the data available is insufficient to determine that these procedures improve health outcomes in any age beneficiary.
That info is from Medicare's website. I know you don't have Medicare, but I think most insurance usually follow suit with what Medicare does. Maybe you could site this stuff in your appeal to your hubby's HR dept. Can you call up Dr. Crookes office and ask them if they perform the VBG? I'm pretty sure they will say no. If they do ask them why. Maybe you can get a letter from Dr. Crookes stating that you need the DS, because of your family history of gastric cancer. And why he doesn't perform the VBG and why the DS is the best surgery for you. You can include that all in your appeal too. Sorry I can't be of more help. I'm not good with looking up medical studies and stuff and hope someone will be able to point you to something on the DS board. Best of luck to you. I know how frustrating insurance companies can be. I really do hope you are able to get your DS.
on 12/3/08 8:55 am - Woodbridge, VA