My Insurance will pay for RNY but not a VSG!!??!!
I saw a bariatric surgeon today and he said my Highmark Blue Shield will not pay for a VSG because I my BMI is not over 50! They will, however, pay for an RNY.
This is SO not right! It is insanity at its best!
I don't want an RNY because I don't want to deal with the malabsorption and other issues that come up with the RNY. I was really counting on the sleeve!
Have any of you run into this problem and if so, were you able to convince your insurance company to pay for the sleeve?
I have high blood pressure, type II diabetes, osteoarthritis, GERD, gout. Good grief.... isn't that enough to get the da*n surgery?
Venting.... I need a plan!
Small people always do that, but the really great make you feel
that you, too, can become great." ..... MarkTwain
I'm ready to fight for what I believe I need. I was hoping to get this done before my 60th birthday in October. Keeping my fingers crossed!
Small people always do that, but the really great make you feel
that you, too, can become great." ..... MarkTwain
I would call your insurance yourself and make sure. If it is excluded then there is nothing the insurance company can do themselves. They are not allowed to tell you that your employer can make exceptions. It's against the rules, though some people will tell you anyway lol. If you call and they do not cover it go to your employer not just your local HR, go higher (if you work for a big company). Find out how to submit for an exception. Some employers make no exceptions no matter what, they don't care. End.Of.Story. Some will at least humor you and some will legitimately review your request.
NEVER HURTS TO ASK!!!
She hasn't got an exclusion. And exclusion is when WLS isn't covered at all because the company isn't paying for that particularly cover. If her policy includes RnY then WLS isn't excluded.
HW - 225 SW - 191 GW - 132 CW - 122
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Provide reasons why you think the sleeve is better for you and why it might be cheaper for them as your insurance company in the long run. You could also provide a list of insurance companies who cover the sleeve to show them that's it's pretty common to be covered nowadays. I know there's been posts about that in the past as well.
Good luck!!!
5'5" Goal reached, but fighting regain. Back to Basics.
Start Weight 246 Goal Weight 160 Current Weight 183
Starting size: 22, 2x
Current size: 12, L
now have atleast five years long term studies on it's effectiveness. Make that call your self & appeal if
they say no! Where in PA are you?
Just to throw it out there... if your insurance rejects your appeals, can you consider self pay? I know it's not ideal, but in some ways planning my surgery has actually been less stressful because I don't have to jump through hoops for insurance. I am maxing out a credit card to travel and have the surgery, but it will be worth it.
My point is, if the insurance refuses to budge, consider it an obstacle, but not a final say.
Good luck!