Question:
I have been denied insurance coverage for VSG

I am 58 years old and my surgeon has recommended that I have the VSG instead of the RBY. My insurance will approve the RBY, denying the VSG. I did a lot of research (for 6 months) and I believe the VSG is right forme. Has anyone else run into this problem? Anywhere to turn to for insurance help? I live in Michigan, Benefit Source (PPOM) insurance.    — Kaymaire (posted on June 25, 2007)

June 25, 2007
Sorry to hear about your troubles. Unfortunately, it is most likely that your health plan is using the recommendations based on the studies that say the vertical stapling is less effective for long-term weight loss. Several of the health plans have listed this procedure as investigational/not medically necessary due to these studies. Read their denial letter carefully and see what reason(s) they give for denying the surgery. Ask them for a copy of the policy that they used to make their decision. The letter should also tell you how to appeal the decision. Until you have both of these pieces of information, it is very difficult to proceed with an appeal. Best wishes!
   — nursenut

June 25, 2007
I think you mean VBG and RNY , the VBG is rarely done anymore for a lot of different reasons, the RNY is the gold standard with a 20 years track records, we do revisions on VBG surgeries for high failure rate all the time. If the doctor does not do the RNY get another doctor with a good reputation that does it say yourself future issues. The Vertical Banded Gastroplasty is not something I would recommend to anyone. We only do RNY and lapband PERIOD.
   — DonnaB.

June 25, 2007
VSG stands for Vertical Sleeve Gastrectomy. It is not the same as the VBG. VSG is a common procedure done on patients over 50 and it is often the first of two surgical procedures for patients over 400 pounds. If anyone out there has experience with the VSG with insurance - or any other words of wisdom is greatly appreciated!
   — Kaymaire

June 25, 2007
Did you get a copy of your insurance policy concerning WLS? I called Customer Service & asked them to send me a copy. I had BCBS of IL & had RNY 2-27 after 2 denials & 1 appeal. It was very helpful to me to be able to read that whole section of our policy. Hang in there!! It took me 19 months after I first asked. But believe me, It was worth it! I'm 4 mo out & down 95 lbs!!!! God Bless. MK
   — asinmouse