Empire Blue Cross Blue Shield says VSG is still Experimental????

 Has anyone had any luck with appealing approval for a VSG with Empire Blue Cross Blue Shield?

I have been approved for both a Lap-Band and an R-Ny, but I really want the Sleeve. They said that the vsg is still considered to be in its experimental stages.
 
Has anyone had the sleeve approved by Blue Cross Blue Shield??

thanks!

Christa

BC/BS is the hardest for appeals on that specific issue, investigational. Some just flat out refuse to pay for it, a few have won through appeal.

VSG is not investigational anymore, not sure why they play these games.

You have nothing to lose by trying. You can go to the ASMBS site and obtain proof there that it is not investigational. Then find a few peer reviewed studies showing that weight loss is superior to a band and safer than a sleeve.

Fight to the bitter end.

I got approved for VSG through BCBS North Dakota, PPO. I had to appeal an initial denial, and BCBS sent my appeal out for an external review on thier own. As usual the reason for denial was "investigational". I am almost 3 months out from surgery and including the 3 months prior to surgery that I was off my immunosuppressant meds, I have saved them more than $12,000 in prescription costs alone. The VSG is a much less expensive procedure than RNY, and way more effective than the band in most cases. I wish BCBS would embrace it instead of fighting it.

Do you have any comorbidities or health issues that could preclude you from the RNY or Band? I could send you a copy of my appeal letter if you want. PM me your email if you are interested. Good luck!