VSG - DENIED by CDI (California Department of Insurance)

This just in... I was denied for VSG due to "investiagtional" by the CDI today.  I can't say I'm mad or disappointed with the decision.  I've been fighting for VSG since Feb 15th and it's now May 29th... this was a long proccess to say the least.  Since my insurance will approve Bypass... that's what I'll be having done soon!!  I am soo grateful I still have a job that will cover my insurance and allows WLS in the first place. 

To those in the struggle... keep fighting for what you want till the end.  

Be well and best in your journey...

Hi,

Just wanted to say that I too feel like I'm in the same boat. I have wanted VSG since Dec 08 and while my doctor is doing the appeal, it doesnt' look like it will be overturned. So I've decided that I too will be having RNY since my insurance covers it. I do also feel lucky to have a job and insurance right now.
For whatever reason, it is mean for us to have this surgery and we will use the RNY as a tool and do what we need to do!!!

Best of Luck to You!

You know, I am going thru this right now myself and I said that if I don't get approved for VSG, then I am going to go with RNY. I had a couple of people say that I should care about myself and not let the insurance company dictate my life. Now should my appeal not be approved then I am not seeking a 2nd one and I will just go along with the RNY because I am most familar with that surgery anyways. I just want to have some kind of surgery before my 30th b-day in September, and to top this all off I have been suffering from back spasms for the last week! By the time I get finish agruing with the insurance company, I could have lost 50 lbs by now! Good luck and I am with you on this!!

 Sorry you were denied the VSG. Do you have any medical conditions that would not make you a candidate for lapband, RNY or DS? I think that's the only way the Dept of Insurance would force your insurance to cover the VSG. I have three decisions in my profile where they've overturned insurance denial of the VSG but I think the patient has comorbids that make them unlikely candidates for the other WLS.  Well I guess that's a moot point now if you've already received your decision from the Dept of Insurance. Would you consider getting the DS it isn't considered investigational. Good luck with whatever you choose.

I'm so sorry you couldn't get CDI to approve - I completely understand.  I tried for 9 months and CDI turned me down also (3 appeals total - stack of evidence and documentation I sent in with appeal was almost 2 inches thick), even with medical issues (take NSAIDS) that would preclude me from having RNY (not according to CDI).  It simply isn't an easy thing to get overturned in CA, and I was unsuccessful.

I got to the point where I was ready to move forward with an alternative surgery when my company switched health insurances.  I'm now 1 year 1 month from my first appointment and having to start all over - I mean completely - I can't even see the same doctors as they aren't a part of the new network.

If you can have a surgery that you are comfortable with - move forward.  All surgeries are a tool, all have their strengths and weaknesses.  The goal is to get the tool that will help you become the healthy person you wish to be.

Best wishes.