Hi I lve in louisiana and i have medicaid. I am having the sleeve which is the first part of the DS.  I wonder if you can have that and then when medicaid starts approving the DS you can continue to the DS stage of the surgery. Just a thought. You might not even need the second aprt of the surgery. The sleeve might just be enough lol. I wish you luck in your journey to WLS....Sherri

I've had all my required pre-op testing and sent all my required documentation in to be approved for WLS.  I have decided that VSG is the best option for me.  I will consider the LapBand but really don't want to do that.  I am not a candidate for RNY and wouldn't have it if I was

I knew going in that my insurance excluded VSG but approved the band or RNY.  I spoke to the insurance person at my surgeon's office today about approval.  I wanted them to submit for approval for the VSG so that we could get a formal denial and start the appeal process.

The insurance person at the surgeon's office said they won't do that for excluded services.  My only option, according to her, is self pay.

I am so frustrated. I don't think what she is telling me is right.   I work with our health plan at work (I am on my husband's ins) and I know we have had members appeal our insurance plan for WLS even though that plan excludes all WLS.  Both my husband's insurance and the insurance at work are self insured plans which gives them alot more freedom when it comes to appeals than with a fully insured plan. 

I have been advised by my surgeon's office to let them handle the insurance company.  I contacted the insurance company myself once before about this and it caused some confusion.

I want to appeal the exclusion but am not sure if it will cause me to be denied for any surgery.  I have a copy of the appeal process thru our insurance and need to go back and read it again.

In the meantime, my husband is talking to HR at his work to see who makes decisions about plan changes.  The TPA only administers the plan.  I need to go to the decision makers to try and convice them to change the plan to accept VSG for this upcoming plan year (beginning 1/1/11).  I don't know what else to do.  I am at a loss.

Self pay is an option but one that would put a real hardship on my family.  It's hard to explain to them why I won't just settle for the band.

Going to Mexico scares me to death and my husband would NEVER go for it.

Anyone have any suggestions?

Im at 40ish days since my letter was submitted From all my contact with them its looking like it will be a denial I just wish they would get it over with already

once i get my letter i can know why there denying me and meet their needs for appeal

im really bummed

Hi as far as I know Medicaid accepts only the RNY ,,,they will denied the DS in a hart beat..,you have straight medicaid???

Does anyone have any experience with this insurance? I am hoping to get the LapBand. Thanks!