sleeve vsg has anyone had it approved?

 I have bcbs massachusetts... Husband needs to be able to take advil because he has had his knees replaced... 

We are hoping blue cross will approve the sleeve as it is the right surgery for him... but  haven't got a lot to go on... 

They were fantastic with  my RNY  so hopeful... but his pain issues are a deal breaker... 

If anyone with bcbs insurance has had some luck with the sleeve being approved we would love to hear from you... thanks

I have BCBSIL PPO and I just found out that I got approved. I was denied twice for WLS but after submitting them 300 pages of documentation and filling a complaint with the state of Iliinois department of insurance, I was approved in 1 day. If you need assistance with anything, I'll be more than happy to help you.

Wisetears, Have you heard of an exclusion being approved? Right now I'm still in the appeal process, and I had Humana w/the exclusion, so i appealed through my husbands job through the union. I talk to the rep thats handling it ,and it has been oveer a year now,she thinks it may go through its just this healthcare reform thats slowing this up. But now she thinks she may have an answer in Jan.2011. So I told her if she doesnt call I will be contacting her.My best friend thinks I will get somehow I will,but sometimes I really dont see it, like I'm wasting my time,but everytime I want to give up something tells me is not the right time yet and something willsoon. My employer has single plans,but she was willing to offer me funds to pay for it, but she didnt have funds either, but she said maybe next year soon and she will keep me posted. So I'm still waiting and we shall see. Thanks for reading.

 
Are you saying that your ins co excludes WLS completely?  If WLS is excluded from your policy it means that your employer does not pay the additional premium for WLS.  If your employer does not pay the additional premium for WLS, you don't have coverage for WLS.

Ins co's want to be paid premiums for services they cover.  It's kinda like having car ins but also having a flood in your home.  Car ins isn't going to pay for your flood.  Medical ins isn't going to pay for WLS if you don't have the coverage to begin with.

If the employer buys the WLS rider, you will have coverage.

To Bubblebutt,  Yes my ins excludes it.I know they not cover it,thats why I'm appealing it, because they did give me an alternative to a new program that will be offered through their ins, and I would be the first to know about. You never really know what will will happen, but the union rep I talked to thats handling thinks it may go through.You never know I've heard of exclusions getting turned over(not many),but its would worth the wait. Thanks for your comment.

 
Wow...

I have never heard of an ins co paying for WLS when they were not paid the premiums.

Crossing fingers for you!

Well on this case its not the ins co its my husbands employer.I am appealing through the his union. So this will be very interesting.....Thanks

 
BCBS bases their decisions on the sleeve because they consider it investigational.  I wouldn't appeal based on NSAIDs, BCBS covers the band and you can take NSAIDs with a crappy band.

I would appeal based on the FACT that a sleeve is not investigational in the least.  It's actually older than the band.  Provide studies showing it is not investigational, the ASMBS endorses the sleeve, and it is anything but investigational.