Question:
Has anyone been denied because they had stapling done

   — Dana G. (posted on March 21, 2003)

March 21, 2003
Denied what? Please explain your question.
   — Delores S.

March 21, 2003
Dana - I had a vertical banded gastroplasty in 1987 that eventually 'gave out' and I regained all the weight and more. I had a VBG revision and an open proximal RNY on 12/23/02 and had no difficulty with getting approval from BC/BS Federal Employee Program. I also have sleep apnea and very bad arthritis in my knees that may require knee replacement. All of these factors helped justify my need for surgery. I think it is well know that VBG's do not hold up over time so it doesn't seem 'fair' that it would be held against you. Is that what you meant?? Diane
   — Diane M.

March 21, 2003
Dana, I work for a self insured company and I have seen a RNY approved on appeal because the lady had had the stomach stapling and then needed a revision because she gained back the weight when the staples gave way. Go ahead and appeal the denial, especially if you can show you have regained weight or had other problems because of this.
   — koogy

March 22, 2003
I had a gastric stapling done in 1978. It was done completely different than they do now. I have gained all plus back. I was approved after my first letter to insurance company which really surprised me. I just had to show medical need-sleep apnea, heart problems, vasular disease, back and leg pain, blood pressure, etc. What I did was write to the insurance company myself also and explained my reasons to have the surgery. They even approved it before they had letter from Psyc., dietian, etc. Don't give up....you just have to make sure you have all your ducks in a row. I even called my insurance company and spoke to a Utilization Management Nurse and she told me what I needed to do. She was really helpful. Good luck.
   — Toni W.

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