BCBS of MI (hcbo)

I'm just starting my journey with WLS and really want the VSG as opposed to all other options.  I need a tool to help me loose weight, but don't want a foreign object in my body w/ a band nor do I want malabsorbtion issues that come with RnY or other options.

Background:  I'm 5'7" to 5'8" depending on which past PCP's chart you look at.  I weigh about 308, so my BMI is at about 48.37.  I've been overweight my entire life and have been obese as far back as I can remember...Morbidly obese for at least the last 10 years.  I've tried dieting, gym memberships, etc.  I have high blood pressure and my PCP says I'm at risk for diabetes, but my numbers are good (fasting glucose was 76 and home checks show I'm never over 85).

So here's my problem.  My insurance covers WLS, but will only cover the sleeve, as I understand it, as 2nd stage to other surgery.  Is there a way to appeal and have them cover VSG that anyone knows of?  Will it all be up to my surgeon and how he codes it?  Being that there is no pre-auth, I have to worry that it will all be done and I will get a huge bill because it won't get covered even though my doc thinks it would.

Thanks for reading...I know it was long.

Sorry, I didn't see your first post before I replied.  I would ask the insurance company how exactly the 2-stage plan works.  What is the time period they (the insurance co.) sets as a requirement between the sleeve operation and the RNY?  I would think that if you lost significantly and reduced and/or eliminated your comorbidities, there would be the proof that you don't need the 2nd stage (RNY) portion.  What?  Are they going to come after you and drag you to the hospital for the other half?  I don't think so.  And they can't reverse payment on the first surgery because you didn't have the "2nd part".  That's ridiculous.  Again, they can't force you to do anything if it's not medically necessary.  And even then they couldn't.  Just saying. 

They probably only cover the sleve as part of a full DS. Have you considered having a DS? I understand you think the idea of re-arranging your intestines seems radical, and, well...it is. I felt the same way at first but I've become convinced it's the right way for me. You should definitely explore it. In particular I would ask you to look at EWL (excess weight loss) numbers. For VSG alone I believe the numbers are similar to lap bands, which give about 50% EWL on average. The DS is 80% on average, and has better long-term maintenance numbers than any other surgery.

That said, if you really have decided that VSG alone is right for you, you are probably going to have to find a surgeon who will state that it's a good option and then go through a couple of appeals.