FepBlue Denial for VSG- W.T.F.

 I am SO mad...  I just got a denial from Federal BCBS for the VSG.  It IS a covered procedure under my plan, however, apparently, Im not sick enough or fat enough for this procedure...  BUT, they WILL approve the RNY?  WTF?  Yeah, thats a GREAT idea.  Lets give someone who is relatively healthy, yet overweight, a procedure that could cause lifelong issues, as opposed to one that has less risk of long term complications.  Are they ******g stupid?!

Do you have the on line version of this policy? Let's see how we can work around it.

 I dont...  I know it is a covered benefit as my surgeon works almost exclusively with Federal BCBS patients so is very familiar with whats covered.  The denial was because my BMI is below 50...  Im sure as hell not going to ballon my way up there just to get coverage though.  They will however cover the RNY supposedly (although I havent had the surgeon resubmit for that yet, because, well, I dont want to deal with malabsorption).  It just doesnt make sense to me, at all.

 So, I spoke to BCBS to try to start an appeal.  Their response?  They sent me in circles between various departments for over an hour, then finally told me I cant appeal a procedure that hasnt occurred yet and to go ahead and pay out of pocket for the surgery and THEN try to appeal.  Yeah, cause IM an idiot- right?  I thought FepBlue was supposed to be the EASIEST to deal with in regards to WLS.  

Sounds like you need to get your hands on your policy. You can appeal, they are BS'ing you! Read your policy and know your options and then write a kick ass appeal letter. Don't screw with the folks on the phone. I was denied VSG because it was considered investigational but made some good points about VSG being a safer choice than RNY. Let me know if you need any help. By the way...I have family up in "Fred-neck"

 Id love some help.  Im really struggling writing my letter, its coming out too emotional...

Where about in Frederick?

Actually I have family in Germantown, Boonesboro, Walkersville and Thurmont. The part of Frederick I know is the Buckeystown/Frederick exit where Value City used to be. I am going to PM you my letters. Take from them what you can. Emotional can be good, not so much with the insurance company but if it goes to a medical review board, they sympathize a little more. Good Luck!

Do you have any chronic pain where you can't take NSAIDs? Can you come up with a reason why you can't have RNY as well as showing that it is a stand alone procedure now for BMIs 30 and up?

Hey girl,
I responded to your comments on a different forum before seeing this.
That decision sounds strange.
Also, OF COURSE you can appeal a decision (using that word instead of procedure) even though you haven't had the surgery.  That sounds crazy.
I think MidwesternGirl makes some good points.

 I do have issues that require NSAIDS.  I had my rheum write a letter supporting that.  And, Ive been pulling a lot of research showing the VSG as a standalone, and other things to support my case against the RNY or Lapband in my instance.  Im getting letters from every Dr in my treatment team as well for my various comorbids and in support.  The insurance Co will be getting QUITE a package from me...