VSG cov w/BCBSTN-PPO-Vandy & Tricare Prime

Does anyone know of a case where they covered VSG? It is my first choice but I don't want to get my hopes up and waste too much time to only be denied over and over again. RNY is my second choice and it is covered by both.

Find out which CPT codes your policy covers. I think this is on the BCBS web site or you can call them. The CPT codes are what the doctor uses for his bill.  I have BCBS of TN and once I got approved I could have any procedure that was covered by my individual policy such as  DS, lapband, RNY, etc.  Also, I used TriCare as my secondary.  Because of Centennial's agreement with TriCare, I did not have to pay over $2000 that my BCBS did not pay.  My only unreimbursed expense was my psych eval.  I stll think that sometimes I'm dreaming...  I mean I got this major surgery and all it cost me was $295!  Also if you need help figuring out what the CPT codes stand for, just let me know.  I'm a medical coder so I can find out. 

I haven't been able to get through with BCBS but I read another post about the Tricare Prime coverage that was very helpful. I called my local MTF and they were doing them but there is a hold on them because Tricare is writing a policy to cover them. They expected it to be done last month so I expect it to be done soon!!!!  She did not say if it was Tricare or Tricare Prime. I am assuming Tricare Prime or both since they have put a hold on their procedures. I'm going to call Tricare Prime to ask about it.

Oh I almost forgot: She also said they have been tracking them and are getting the same results with VSG as with RNY. That is wonderful news for my diabetes!

Have you considered the duodenal switch?   It's the sleeve plus a little extra and it has a great cure rate for diabetes.   Dr. Houston at CMC does this proceedure.

I did consider it. It also is not covered by both of my insurance companies.