My Insurance will pay for RNY but not a VSG!!??!!

I am so upset! 

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!

I used to do insurance verification for my surgeons office and I hate to be the bearer of bad news but unfortunately if that's the plan that your employer has selected then there is nothing you can do about it. It's called an ''exclusion" and that means its just nonexsistent in the plan. Sorry!

Highmark Blue Shield oversees our insurance, but my employers pays for it I believe. I wonder if that will make a difference and perhaps they'll make an exception for me.  I personally know 11 people who have had the RNY paid for by our company.

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!

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.

Appeal appeal appeal!  There are several sleevers who were originally denied because their insurance only covered the band or RNY.  But they eventually got it overturned and were able to get the sleeve.  I can't remember who they are... you might try doing a search in the search box up top.

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!!!

 I haven't been Sleeved yet, but Good Luck!  Sorry your having a hard time...

  I waited a year for Blue Cross Personal Choice to cover the sleeve.   You should call yourself, he may just not be sleeve friendly.  I've heard that as of 1/12 all insurance is paying for it now because they
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?

Definitely not true that ALL insurance is paying for it... my insurance doesn't cover wls of any kind. 

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!