Did BCBS Federal cover your VSG???

Hi VSGers,

I had my surgery on 20 May 09.  The doctor said that BCBS Federal would not cover this surgery because he is out of network.  He said other patients did self pay cash and then BCBS Federal would reimburse them.  That is where I'm at right now.

 My doctor office turned in the claim with the CPT code of 43659 for the surgery, it was denied.  I  checked the bcbs federal  medical policy and 43659 is not one of the codes.  I also checked Wellmark bluecross blue shield medical policy 43659 is for mini gastric bypass.  I asked my doc if he would turn in a cpt code change to  43843 which is for a other gastric restrictive procedure without gastric bypass, and other than Vertical Banded Gastroplasy.  I'm waiting for his response. 

I have read that some of you used the cpt code  43843 and the vsg was covered.  I just wanted to get a head count.  Incase I get denied with the 43843, I 'm going to ask why some people get covered and some do not with BCBS Federal Employee Program, Standard Option.   I will then appeal.   

Thanks everyone in advance for your response.

Blessings,
babygirlinokc

VSG   FED BCBS...BS means??
Anyway This a video case study of over 1000 vsg patients  in 2008! No question the VSG is the way to go. That is right.
When/if  they sat the procedure is  is whatever denied here is the stuff.  You will need to concentrate on the shield/regency side of the insurance they do the doctor and proceedure approval.
First go to  http://www.ssat.com/    then on the left push the 5th one
down abstracts and meetings. Please CLICK the 2008 ABSTRACTS... almost
there!
Then cut and paste this to the address bar and hit enter
http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meetin g(3)-Cirangle.htm
it takes about 3 min to load. If you have any problems go back to 2008
abstracts click then At  May 19 2008 click the bullet. Then under 04
Laparoscopic Vertical Sleeve Gastrectomy for Morbid Obesity: A Report of a
Five-Year  click view video presentation and slides.
It is amazing. I tried to contact you earlier with no reply. Good luck.
If you get the stall or more waiting file a grievance with your state insurance board asap to help them decide. Under state pages....Let us all know!
Glacier-bear

Thanks Glacier-bear.  I appreciate your input.  I will check it out.