Aetna and VSG
R. c
on 1/22/09 4:32 am - nashville, TN
on 1/22/09 4:32 am - nashville, TN
I don't know if it is different for every plan, but this is what my plan's clinical policy bulletin says:
http://www.aetna.com/cpb/medical/data/100_199/0157.html
http://www.aetna.com/cpb/medical/data/100_199/0157.html
Experimental and Investigational Bariatric Surgical Procedures:
Aetna considers each of the following procedures experimental and investigational because the peer reviewed medical literature shows them to be either unsafe or inadequately studied:
- Loop gastric bypass
- Gastroplasty, more commonly known as “stomach stapling" (see below for clarification from vertical band gastroplasty)
- Sleeve gastrectomy
- Mini gastric bypass
- Silastic ring vertical gastric bypass (Fobi pouch)
- Intragastric balloon
- VBG, except in limited cir****tances noted above.
-
LASGB, RYGB, and BPD/DS procedures not meeting the medical necessity criteria above
~* Rosie *~ 2-16-10
Aetna has a 50/50 approval for the sleeve. I was denied but then there was three people on the sleeve forum that was approved after me. I'm in the process of appealing mine. It has a lot to do with your surgeon. If he will fight for you then you have a good chance. Also it depends on your comorbids. If you have proof that you need to take nsaids then you can get approval. Go for it. Appeal it if you are denied. Also they are suppose to be re accessing the sleeve this February. So we may be lucky and they could start covering it at that time. Skye
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