Question:
DMHC Denial

I just got my letter in the mail today telling me they were "uphelding the health plan's decision" to deny me approval of VSG and agreed with the health plan's alternative options of RNY, VBG, band, biliopancreatic bypass, biliopancreatic diversion with duodenal switch or laparoscopic bariatric surgery. Says the plan recommends one of those procedures. It's a good thing I didn't wait for this answer before I started the process for RNY!! Does anyone know if this mean they will probably most likely approve RNY on the first shot? I know it's hard to tell but they did say it in all of the denial letters I have received that they would, as well as the phone call I made to the person handling my appeal.....    — Papoose79 (posted on August 16, 2009)

August 16, 2009
Tracy, While there are no guarantees in life, it sure sounds like your Insurance Co is telling you they will approve anything other than the VSG, including the RNY - will they approve it on the first shot - well, if they said they would, and you have it both in writing and documented conversations, then chances seem good for you that they will approve first time around for the RNY. Best of luck to you :). Blessings,
   — rebalspirit

August 16, 2009
Most likely they will approve on first go round. My plan also considers VSG "experimental" and will NOT approve this is an option.
   — rkurquhart

August 17, 2009
Even though w/l surgery has become very popular and insurance companies don't always do what we want. The majority of insurance companies will almost 9/10 approve the RNY. Probably because it was originally used for patients that had stomach cancer. Then the medical world said "Hey look people can lose weight and still be healthy". So they will approve the RNY on the first round, if you have all of your paperwork. I left out one paper and they denied me, but once I got the paper to them, they accepted my request. So the insurance companies are still trying to convince the non medical world that the other w/l surgeries are just experimental, when in fact they work just as well. The weight might come off slow, but the RNY is a good choice if you have 100 lbs or less to lose. And those with a sweet tooth will benefit from this surgery. If your BMI is 35-55 kg/m almost all insurance companies will approve the RNY.
   — Kristy

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