VSG to RNY Insurance Approval

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

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.

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.

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

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

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.