Best way to start if it's "investigational"?

Okay so I've read here that there are new codes for the sleeve procedure. I have Wellmark BCBS of Iowa and I believe the sleeve is still considered investigational. So what is the best way for me to go about starting this process? Do I call the insurance company and ask outright if they cover the sleeve or is that a no no?

A few months ago when I asked a similar question here the advice I got was to just go ahead and ask to have prior approval for WLS. The idea was that way they would'nt tell me no way from the start because they'd be thinking I was having RNY or the band. And then later I ask for the sleeve.

Do most of you agree with this as the way to go about it? I'm just so worried I won't get approved and then I don't know what I'll do!! I want to go to the surgeouns seminar fairly soon and they ask that you know your insurance before you come. I don't want to show up the the seminar knowing that the sleeve is considered investigational and have them think I'm just wasting their time. It's just that I have read on here about people still getting approved for this even if they are in the same boat as me with insurance.

So what suggestions do you all have for me? Do I call my insurance company and ask about the sleeve? What about the code thing? Is that something I need to call and ask about too? Sorry for the zillion questions I just really want to get this right the first time.

Personally, I would start by getting the denial in writing. I mean it's  99% likely you will receive a denial if the insurer believes the procedure is investigational. If you have their denial in writing, there may be something in that language you can build a strong argument on (aside from the obvious argument of why they consider it investigational). Also, start searching for supporting materials (i.e. new studies, other insurers covering the procedure, other instances where your insurer has overturned the denial, etc.)

Others may disagree with this approach & have other insights to offer.  Either way, best of luck to you!

-Sam

Thanks so much, I just wanted to bump this!

Wow, this is kinda weird. So I'm also in Iowa and I have Wellmark through the University of Iowa grad care. I want to get the DS done, but after looking through Wellmark's information, it seems like it will be denied. I still plan to ask for approval though, to be sure!

Have you had any progress on this? It seems like we're really in the same boat here - I will let you know if I find anything out.