BCBSNC Approved VSG finally!

I am just beside myself. I want to cry but am at work so I am trying to compose myself but after the 2nd level appeal..BCBSNC approved me for VSG. I am so excited..so nervous. Wow! Don't accept your insurance company's denial. Fight for what you want!

YIPPEEEE!!!! That is so fantastic...hip, hip, hoooray!!!

I am so excited you are getting the surgery YOU want!  I was denied for RNY the first go round b/c they said I didn't have 6 months supervised diet & exercize...which, actually, I didn't when I looked at it.  I just did my 6th appt. today & am going to do one more on February 2nd (for good measure!) and then I should be good to go...they are holding my denial in first level appeal because I have 180 days to request an appeal & I haven't done that---I am going to do it in February & I should get a yes...so, cross your soon to be skinny fingers for me......

When are you going to have your VSG?  Okay...and why did you fight so hard for that surgery?  I am sort of new to all of this, so I want to know more about VSG...what are the benefits vs RNY or band? 

  Congrats!! Micheala.

I looked inot RNY over  years ago and the re routing of my intestines plus the dumping syndrome scared me to death. I just didn't like the idea of what could be complication wise 10-30 years down the road with malnutrition plus I have seen a few people put their weight back on after RNY and I have a cousin who 3 years post op if she eats sugar she gets really sick and I said that I would be that person who could never touch sugar again. The band was my  choice and what I was going after since it could be taken out if there were complications but then I started reading more and more complications like band erosion, slippage and I didn't like the fact that if you didn't chew your food to puree you might get choked and throw up. I hate throwing up and then I started reading about VSG. The scary part of that is they remove 85% of your stomach and it is not reversible but no re routing of the intestines, no foreign device in my body and everything stays in place. You have a fully functioning stomach but can only eat small amounts and looking down the road after I reach goal, I might could have the occasional bite of cake or pizza without fear of dumping or getting stuck. Trust me I really contemplated the removal of the stomach but then I looked at it like this....if I had cancer I wouldn't hesitate for them to remove an organ to save my life...to me my fat is my cancer and removing part of my stomach will give me my life back. Good Luck on your journey, whatever you choose.  RNY is great for some folks, it just wasnt for me. If I couldn't have the VSG I would try once again on my own but if they told me have WLS or die within a year...I'd have RNY in a heartbeat.

Congratulation Good for you for not ever giving up and fighting for what you want. This will make it that much easier for others who are trying to get the VSG in the future.No one should dictate what we do with our bodies. I wish you the best of luck and hope you are able to get a surgery date soon. 

Congrats!

If you don't mind my asking, what are BCBSNC 's criteria for WLS? Also, was VSG considered experimental?

VSG was/is considered investigational/experimental. As a matter of fact at the  bottom of their approval letter, it says we will abide by the board's recommendations but BCBS still feels VSG is investigational in nature and my results will not facotr in with future such requests. I don't remember the criteria off the top of my head but I think I have a copy of it in my blog but it is your usual criteria, 5 year obese weight history; BMI over 40 or35-40 with 2 or more co-morbs, 18 years old...the usual stuff.

I am so happy for you!!!!! Can't wait to continue folling on your journey. You've been at it a while so I know this must feel oh so sweet for you right about now!!!!
Have a great weekend!

 I AM SO HAPPY  FOR YOU WHAT PPOCEDURE CODE DID THEY USE??????

That is so great.  My husband needs WLS, but because he's also been diagnosed with Crohn's the VSG is the only one the Dr. will consider.  Unfortunately BCBSAL considers it experimental.  Our doctor wants us to write a letter to the medical director, but I don't know what to say.  Should I write the letter now or just try to get it approved and then appeal?  He was already approved for RNY and a 2 weeks before his surgery date they found the Crohn's, so no surgery.  Could you help me write the letter?  Could I see what you wrote to your insurance company that worked?

Thanks!