Question:
Has anyone seen this exclusion?

I have insurance throught United Healthcare and under exclusions they list: Gastric Stapling for weight loss Is this the same as gastric bypass? Has anyone else had this specific exclusion and still been approved?    — Mary D. (posted on April 24, 2001)

April 24, 2001
My understanding is that gastric stapling and gastric bypass are different procedures with gastric bypass being the most successful.
   — Lisa B.

April 24, 2001
They are different procedures indeed. My doctor doesn't even do the stapling alone any more, because he says it isn't near as successful. You may have to get particular with the insurance over this one though. Use their own words against them.
   — Amy K.

April 24, 2001
Perhaps they exclude gastric stapling because they don't feel it is cost-effective to pay for a surgery that has a failure rate higher than that of the RNY. I would contact your benefits rep. and ask him/her to define exactly what they mean by "Gastric Stapling" If the response is any weight loss surgery, that doesn't mean you still couldn't get an approval. If the response is the description of a VBG, then you may get approval for the RNY. Just make certain that you get a clear and concise answer from them. If they are too vague the first time, ask again and again until you get the answer you need. Good Luck.
   — Diana M.

April 25, 2001
My insurance wouldn't pay for "gastric stapling," but as I looked into it, I discovered that "gastric stapling," in their eyes, is the old procedure that's not used any more. So they wouldn't cover a sugery that's not performed, but they had no problems covering VBG and Roux-en-Y procedures. If this is the entire exclusion, you've got semantics on your side.
   — Suzanne B.

April 25, 2001
"Gastric Stapling for weight loss" is just that. Its a vague exclusion and one I would think you could get around if the procedure you are seeking is not called or coded as "gastric stapling". I really think you have a good shot. Who is your insurance? Have you seen others w/ it on this site who have had it paid etc? Holler if I can be of any help. I have worked in the insurance industry for quite a while in Oregon.
   — Dawn R.

May 23, 2001
I want to thank everyone that posted an answer to my question. I found out yesterday that UHC approved me. They did request more info on the procedure first to make sure that it wasn't the old gastric stapling procedure.
   — Mary D.

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