VSG to RNY Insurance Approval

(deactivated member)
on 4/3/14 11:40 am

Drs. office submitted approval on 3/11/2014. I found out today it was denied.  This is the crazy part, I was approved for medical necessity but it was denied due to the code used for surgery since it was too general.  REALLY.  Ins. said it can be appealed or a peer to peer.  Anyone have any idea how long that takes.  Really need to get this done in the next few weeks or I'm going to have to postpone for 6 months.

Still have to talk to drs. office to see what their insurance person says....

Nan

pineview01
on 4/5/14 9:07 am - Davison, MI

Sounds like your surgeon didn't code it right.  It is most likely confusing as they don't have a set code for VSG to RNY and like the do for band removal and than a vsg or rny.

Usually the VSG is the first stage of the DS.  Going VSG to RNY really leaves you with a ******* surgery.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

(deactivated member)
on 4/5/14 9:15 am

Thanks,

Surgeon's office says they coded right.  Now I have to wait while they do a peer-to-peer review.  Its so frustrating since the only one who seems to be in any hurry to get this over with is me.

pineview01
on 4/6/14 1:28 pm - Davison, MI

Hopefully they can get it worked out in the peer to peer.  We usually are the only ones in a hurry.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

Whit
on 4/7/14 3:31 pm
Revision on 12/10/12

Good luck. But I have to ask did you look into doing the second stage of the DS? I revised from RNY to DS. RNY is really not a long term solution for most. 

Best,

Whitney

Revision from RNY to DS 12/10/12 Dr. Ara Kesishian BMI: 19

Created by MyFitnessPal - Nutrition Facts For Foods

 

 

 

          

Amy Farrah Fowler
on 4/11/14 8:32 am

What a shame this poster deactivated, since they are clearly getting bad advice from a surgeon with limited skill.

Hate to see a good sleeve destroyed into a RNY pouch, when the DS is halfway done, and more effective.

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