VSG cov w/BCBS TN-PPO-Vandy & w/Tricare Prime

Does anyone know of a case where they covered VSG? It is my first choice but I don't want to get my hopes up and waste too much time to only be denied over and over again. RNY is my second choice and it is covered by both.

Tricare Prime does not cover VSG. They cover gastric bypass and RNY. You also have to be 100 pounds overweight (they use Metropolitan Life Table medium frame) and have 6 months of documented weight loss with nutritionist. I hope this helps

Thanks.

RNY is my second choice. I have met the requirements for my BCBS. I also have been seeing a dietician since February and will continue with that at least up to surgery. My starting weight (243) met the 100 lb requirement. I did find out that the MTF near me has been doing VSGs. They are currently on hold there pending Tricare's revision of policy to cover them. I hope to hear that they are covering them soon. They expected it to be done last month but still waiting.

BCBS denied my VSG but I had it overturned through appeals.

tricare prime is covering a VSG on a friend of mine that had a bad lapband experience.  I think she is having it done at a MTF though and that might be why its being covered.

Just wanted to add that I was not asked for any type of weight loss history and did not have to do any type of diet prior to approval. I had surgery with Tricare in March.