Question:
Insurance denied sleeve, approved bypass..what should I do?

I was so looking forward to the sleeve. I am 46,female, 245 with a BMI of 40.6 with no other health risks. I was impressed with the sleeve's lower complication rate, and the non-malabsorption. I don't know what to do....I am scared to death of the risks...major being death! I read all of these stats, but a lot of them seem to be from 5 years ago. Does anyone know what the death rate is this year, and what truly are the biggest complications? Thanks for any help you can offer.    — san63 (posted on February 8, 2010)

February 8, 2010
It seems that one of the biggest complications is the leaky pouch. Other higher risk things I have read were pulmonary embolisms. I am in the same boat as you. My GI doctor has recommended me to have the sleeve. I have peptic ulcer disease and they wont ever be able to access your stomach without surgery is what he told me if I have RNY. My daughter is healthy besides poly cystic ovaries and is going in for RNY surgery on Thursday. So I think as long as number one you trust your surgeon, and he sends you for as many consults as you need/ Like the cardiologist, pulmonary, psychiatrist and all blood work I think you will be fine. For me just through the blood work they found out that I have a clotting disorder and will put a filter in before I have surgery, so that helps with the blood clots. I had to get more medical necessity before they will approve my sleeve. Good luck with everything. Dawn
   — Hilkerrt

February 8, 2010
I was a self pay either way but after much research decided the sleeve wasw the prefect answer. I am 50 years old, diabetic and had my surgery on 12-29-09. It was a breeze and I have already lost 42 lbs/ I too wanted the lower risjks, no alabsorbtion issues and to know that I didnt have to give up entire food groups. Have or can you consider self pay?
   — dawncervenka33

February 8, 2010
Sandy, just to ease your mind, I had RNY/LAP 3 years ago and had absolutely no problems. I went to St. Vincent's hospital in Cleveland and had the best surgeon around- Dr. Ben Meir. I lost 136 pounds even though I should have lost another 30 pounds. My fault - I didn't exercise like I should have. I have no malabsorption problems (blood work done every 6 months). I would have RNY over again.
   — Muggs

February 9, 2010
You can try to fight the ins co, but not likely to win. You are most likely either going to have to pay for the sleeve yourself, or get the RnY. I was self pay for the sleeve, and frankly, I think it was the best thing I ever did. SOME ins companies will do the VSG if the DOCTOR INSISTS. See if you can get your doctor to give you a letter saying it is medically necessary to have the VSG instead of the RnY.
   — hubarlow

February 9, 2010
I went thru this last year with my insurance for the VSG. I took it all the way up to the Dept of Managed Health Care and lost. My insurance had approved all WLS except VSG. I could have gotten a DS but instead went with RNY. I am very pleased with my RNY and I was scared as hell of dying during surgery but here I am almost 5 months out and 67#s later still here complication free! I think they have improved this surgery so that the fear of complications should be less of a worry now. Being that you do not have any health risks are a plus if you ask me. Think about it and if you are able to self pay for a sleeve go for it! I would rather self pay plastic surgery when my insurance covers WLS. Good Luck with your decision! By the way, I am a slow loser because I don't follow all the RNY guide lines like exercise, although I usually do follow the diet I have slipped up a few times and I am still losing. But remember not to do that :)!
   — Papoose79

February 9, 2010
My insurance also did not approve the sleeve only RNY and Lap band so my doctor got the VSG covered by listing it as stage one of RNY surgery and that worked. I am very happy with my sleeve. Ask your doctor if this is an option for you.
   — Lisa von Wallmenich

February 9, 2010
Check with your surgeon on the risks and complications. I studied all 3 and for me the Lap Band was my preferred choice. The other 2 were "permanent" altering my body and both had "dumping syndrome". The only reason RNY or VSG would be better for me is for my GERD which may be worse on Lap, but not for certain. You can avoid problems with mal-absorption by taking a daily cocktail of liquid, crushed or chewable vitamins and supplements. The RNY is the "Gold Standard" for WLS - you should re-consider this option and be glad that your insurance does cover it. From people I know who have had RNY they deal w/malabsorption and eating difficulties by eating what stays down, in some cases, not the best choice in foods and it shows in very slow (stagnant) WL progress. I hope that w/Lap Band I will have a good degree of success, but it all hinges on Your Own Committment level. If you're going to have surgery, you should be prepared to make the changes that will follow to achieve your goals - one day, one right choice at a time. Good luck to you!
   — Terri H.