Anyone have to appeal to get BCBS PPO to cover VSG?

Right now, BCBS PPO covers VSG for patients with a BMI over 50.  Mine is 46.  I can get the RNY or band, but don't want to -- long story.  I have high bp and am pre-diabetic so do have co-morbs.  So my question is this; has anyone been in this situation?  Not too far under the BMI "minimum", but still been approved or had to appeal then got approved?

Also, I've been seeing posts about VSG "rules" possibly changing next year.  Any new info on that or something to back that up? 

Well, I don't know much about your insurance, but I was told by my surgeon in California that Medicare was expected to cover VSG beginning in early 2010.  He said Medicare was just waiting on a code to be assigned to the VSG.  Supposedly, once Medicare covers, most of the other insurance companies will follow suit.  Since a code has now been assigned for the VSG, I'm hoping the ball will start rolling  'cause I'm wanna get sleeved SOON!

HMM... I went through the whole process earlier this year and I have BCBS PPO of CA and I FOUGHT... I exhausted ALL of my appeals and did not win on the VSG.. They did not cover it at all and my bmi is over 50... I just heard from my surgeon's office that the VSG will have  it's own CPT code starting effective next year sometime and  is covered by United Healthcare Insurance Company in Oct. 2009, so maybe it'll get easier to get that approved next year?

Tell your doc.... demand that he do a peer to peer review.  As of today this is your only chance.