VSG & BCBS of TN

Has anybody had luck getting a vsg approved by BCBS of TN? I  have been told they wil not pay for it...

All BCBS of TN plans are not the same. Whether or not your plan covers a procedure depends upon your employer.

What this means is that if someone else with BCBS of TN told you they were told the VSG was not covered, it does not mean your plan won't cover it...unless you both work for the same company and the other person was denied during the same plan year. Plans can change from year to year for the same employer.

You can always call the customer service number on your card and ask exactly what is covered and what is specifically excluded. If a plan does not specifically exclude something, you have a chance of getting it covered even if it is not listed as being covered.

Just so you know...I am the Benefits Administrator for a company of over 5,000 employees so I do know a thing or two about medical plans.

thanks for the info... i do have the PPO and they list the VSG as investigational.......I am wondering if it could be approved if somebody has had other issues.......... I am lactose intolerant and have had a life with IBS like problems....if the RNY could make these problems worse the VSG might be deemed medically necessary.......

I don't think you are going to get approval for "medical necessity" based on IBS and/or lactose intolerance.

I have had IBS for over 20 years and if anything, RNY has improved the condition. I don't know if it's because I'm not eating some things that were triggers for my attacks or if it's the surgery itself. Whatever it is I will take it. I haven't had a bad attack since my surgery.

I am also pursuing VSG with Dr. Williams. I have BCBS FED VIP which falls under BCBS of TN (how - I do not know - but it does). I work for the U.S. Department of the Treasury. Anyway, I have been told by the folks at Vandy that BCBS is one of the easier insurance companies to deal with as far as getting approval. I reviewed my benefits booklet thoroughly and the VSG is covered per the fine print. I will be completing my Psych exam this week on Wednesday and that is the last hurdle I have to clear. Vandy will then put in the paperwork with BCBS. I expect they will have a quick reply and I should know if it has been approved by the week of 02/15. I will keep you posted as to the approval.

The doc wasn't sure if the lactose intolerance would be aggravated with surgery...he is checking with his colleagues...it is liveable now....but when I was  a child and teen it was horrible....... it sounds alot like the dumping syndrome....... I would get rashes, have extreme knife-like abdominal pain for hours, nausea, dry heaves, diarrhea,the sweats, etc...it was rough..... when I was an infant I had projectile vomiting, diarrhea, was losing weight,,,,until soy formula was introduced........ I can now eat alot of foods that have lactose in them, if i eat yogurt daily.........

The IBS-like syndrome is probably  from the lactose intolerance not a separate condition.................so a roux-n-y pouch would not digest in the same way a normal stomach would.......then it would go through the bypassed duodenum......it could cause some hellious dumping.....

On a good note my egd yesterday looked really good!!!!  It sounds like it is better than the one I had 11 years ago.....