VSG and Insurance denials

I see a lot of people getting denied for VSG by their insurance companies because it is an "experimental" surgery. Why are you people...(I mean that in a nice way)...Not just opting to have the Roux En Y??? It would take a lot of stress off of you as far as insurance approvals go...I say there is a way better chance of getting approved for RNY than VSG. Please enlighten me.

Hi Amber... personally, I stlll feel VSG is ther PREMIUM surgery to have.  Honestly - it's a no brainer procedure when put in the line up of WLS offerings.   For me... VSG works just as well as RNY without the dumping / vitiamin defiencencies - RNY posses.  That's what drew me to the surgery quite frankly.  HOWEVER - since I lost my 3 appeals and 1 independant medical review with the CDI... i will be have having RNY next month as that is what the insurance will pay for.

When you beleve in something you feel will be the BEST solution for you... that's what we do - we fight for it!  Don't you? 

Absolutely agree with previous poster!! I personally know my body and do not want to deal with dumping, malapsorption, hair loss, etc.... I have been denied as many times as previous poster but am still holding out.  I absolutely do not want any surgery done to my intestines at all... Also looked into the Lap Band, but after my research, do not want that at all anymore.

Hi, my reasons are:

- I have chonic anemia issues and my surgeon doesn't want to risk aggravating the problem with an RNY (malabsorption).  

- My lap band was recently removed and my surgeon doesn't think the rerouting part of the RNY surgery would be effective or even possible given the damage the band caused.

- I want to be able to eat normally, but just a lot less!

 

I didn't even think of adding my issues with anemia in my appeal letters. I don't have any issues now, but in 2004 I had to have 2 blood transfusions for severe anemia and all my life I've been pretty low to normal.. I didn't know that interfered with surgery. I might have to bring that up to my dr.

m0mmy, yes, that's compelling information that should be included in your doctor's letter of medical necessity to the insurance company.  My doctor made it clear that the RNY would most likely make my anemia worse.

Well, I went in looking at RNY and then was introduced to VSG only to be denied by my insurance twice. So I go see the surgeon yesterday and was told that he is not willing to do RNY on me, and hell naw I don't want lap band I honestly feel that it will be a waste of my time.

Hi Amber.
Many of us have done a lot of homework to find out .
The vsg doesn't bypass anything your stomach is just smaller. The likelihood of serious problems down the road are greatly diminished as your stomach is still intact. Your body as you get older will still be able to get many  more to the nutrients you require to continue a healthy lifestyle so much fewer pills are a requirement. The result have been outstanding overall.
 I have been denied at the 11th hour for this surgery by bcbs after being approved and am going to do everything in my power to get the vsg. I watch the blogs every week for a breakthrough. It is insane how blue shield can continue to  refuse service to us when it is already proven itself  as safe and successful in the first part of the 2 part surgery. If I had a bmi of 50+ I would just do the first part and you are off!
Take care
TJ