Question:
BCBS of NC denied VSG approval. How do I appeal, or does my Dr. do that?

   — gr8lakes (posted on May 12, 2010)

May 12, 2010
It depends on your surgeon's office. Some will fight for you and some will not. What did they say when you asked? It will also depend on the reason for denial.
   — Caribou ME

May 12, 2010
My office would have if I would have needed it. VGS they say is so new..i have bcbs of Pa. they approved mine right away. If they denied vgs, chances are they will approve the RNY, just need to ask them. Good Luck to you, keep us informed...thanks
   — [Deactivated Member]

May 13, 2010
My Dr. filed the appeal for me but I found out why it was denied first and made sure they had everything they needed and then some. Some insurance companies only give you 3 trys so try to help your Drs. office in making sure they have everything they need. Be sure to call your insurance company yourself even if your dr. says they will take care of it. Tammy
   — Tammy C.

May 13, 2010
My insurance would only cover the VSG by my doctor saying that I needed the RNY in two stages and the VSG was the first stage. I was able to get full coverage for the surgery this way. Talk to your doctor about it.
   — Lisa von Wallmenich

May 13, 2010
Vertical sleeve gastrectomy as the first stage of an RNY? It is the first phase of the biliopancreatic diversion with duodenal switch (BPD/DS, usually shortened now to DS). I can't see it as the first stage of an Roux-en-y (RNY), which involves a completely different configuration of the stomach. Is this something new, anyone?
   — Virginia N.

May 13, 2010
BCBS still views the VSG as experimental. They were the same way with the band a few years back. I had my VSG in Aug. of last year and could only get approval for RNY because it has been around longer. I would go with the VSG being the first half of the RNY, and get it done that way. Good luck my friend!
   — Bonnie H.

May 15, 2010
I have BCBS of NC through the schools and it is on the approved list. I haven't had mine submitted yet but that is what I want to have.
   — Price S.