vsg not covered

So when I first decided to look into wls I was set on the lap band. Then as I learned about rny and vsg I like everything about the vsg. The problem is my b.m.I. is too low (42) w my ins. it has to be over 50 ...aghh I have prayed n don't want the rny. I am a very optimistic person and praise God my case manager says they will "consider " it sooo that wasn't a no right? Anyways would so appreciate prayers I need to be sleeved!! Not detoured lol tried to type rerouted

Prayers coming your way. Good Luck!

I take it that they will approve an RNY for you? Do you have any issues or family history of issues that require various pain relievers such as NSAIDs - arthritis or something similar? If so, that is often an avenue of appeal for a VSG or DS against the RNY as those types if meds are well known no-no's for RNY patients but are usable with the sleeve.

Fight for what you want!!

I did not fight hard enough back in 2007 and settled for the band.  5 years later I was having my band removed and getting revision surgery to the sleeve.  At almost 2 months out I weigh less than I ever did with the band.  I love my sleeve!!

Thanks for the prayers. N yep I'm sticking to my guns I will fight for it n woo hoo to the sleeved u!

Yes, they will approve, as long as I take a psychological evaluation (this Friday) and 3 mos w a nutritionist (2 more mos.) I get horrible pain in my knees and yep take ibuprfen n also for p.c.o.s. I know there are guidelines the insures follow but I believe in prayer n I just know this is the right surgery tor me. Saying so I will do what my surgeon suggests I have faith I will be sleeved by the new year so enjoying my journey. Even this part I accept its not a race its my journey

If the ibuprofin has been prescribed, or at least recommended and noted in your records by your physician(s), then that should be enough to counter the insurance company's approval of the RNY over the VSG as that incompatibility between NSAIDs and the RNY is well documented and known throughout the industry. If it has been something that you have been taking on your own, discuss it with your PCP and have it noted in your records and maybe have him write a letter to the insurance company so stating that fact, which maked you an unsuitable RNY candidate (and ideal for the sleeve, of course!)

Continue to fight and appeal. I didn't have a choice when I first checked on wls. I could not have anything with malabsorption and at 35.8 BMI BC/BS would not consider paying for a sleeve. I got a band and loved it but inon 8/21/12 I had to revise and this time they paid for a sleeve with me at a much lower BMI. Makes no sense. Their initial requirement was bmi of 40 with comorbidities or 45 without. I would say that you can make a very good case for yourself. Get your surgeons insurance guru behind you.

I will be praying for you. Keep us posted.
Sue

Sorry to hear about the set back.  I've heard other people writing additional letters to their insurance carriers and/or maybe an additional note from your doctor?  Hope everything turns out well!