VSG Investigational to BCBS PPO! Would you go ahead and send letter in that it's not?

I already contacted BCBS and they said the usual that VSG is investigational...blah..blah...blah.

So would you go ahead and send all your supportive info you've gathered on the 1st letter of approval to them or would you wait until you are offically denied to see what the exact perimeters for denial are????
TIA

I would use it as a rebuttal.

Yes, I would officially wait for the denial and then plan out your appeal from there. If they say that the procedure is investigational, then I'd probably have your surgeon's office help you find all the articles that talk about its effectiveness and show the procedures outcomes. You should also accompany this appeal with a letter written by your surgeon that states all the reasons that this surgery is appropriate for you. Then if you get a second denial, you should request that your surgeon does a peer to peer - this is when your surgeon has a discussion with the medial director making the decision on your case.

If for some reason, you cannot get your insurance to approve your surgery, let me know, I work for a company that provides complication protection for the VSG and other procedures for self-pay patients. This way you know how much up front the surgery will cost and will not have to worry about the costs of care for covered complications should they happen. Please let me know if you need any more help or have questions!

Best of luck to you!
Billie

YES! 

I noticed two recent posts about BCBS PPO (two different states) approval for VSG.

I just finished my 6 month supervised diet & am gathering paperwork to send into BCBS PPO (IL) for DS (which is also considered investigational).

Find out the code number they say is investigational.  My Blue Cross called 43659 investigational but not 43843.  It seems that 43843 is becoming the standard.  I'm trying to see if my surgeon will use 43843 or if I have to find another surgeon.

Ok I will keep you updated I don't go thru the motions until after Feb 2nd.

 I agree that you should wait for the official denial before you appeal. There are only so many appeals that you are allowed through your insurance company.

In your appeal provide all the studies and data you have proving that the VSG isn't investigational. You could also include a list of people (with their real names) and insurance company that have approved the VSG. Can your surgeon provide a letter to you on why the VSG is better in your personal case? Is the RNY or DS or lapband contraindicated because of an illness or medications you need to take? Anything that you can provide will help. Many insurance companies deny because they can. All you can do is appeal and hope for the best. If you really want the VSG and self pay is an option I believe I've seen rates well under 20k. 

Have you looked into the DS? It is not considered investigational or experimental anymore and is even covered by Medicare. The DS offers restriction with the VSG stomach and malabsorption with the switch. The malabsorption with the DS is not that bad and only requires a little more supplementation than the RNY and yearly labs. The DS also has the best stats for long tern excess weight loss and maintence. Check out the DS forum if you are interested. But if your mind is set on the VSG then do everything you can to get it. Best of luck to you. Neely