VSG not covered but could get authorized

Carey W.
on 4/2/14 2:01 pm, edited 4/2/14 4:13 pm
RNY on 12/04/14

If the surgeon (Dr. Grant Searles) submits for medical necessity that the sleeve is the preferred option for me, insurance could authorize for it but its otherwise not covered.  I am disappointed and yet crossing my fingers and hopeful.  The insurance covers 5 different procedures, all of which are bypass.  Has anyone else done this and if so what has your experience been?  Is there any concrete reasons a surgeon could use to support such a request and if so what would they be?  I am hopeful but worried.!  consult appt is on the 23rd of this month.  Thanks!

christytea1950
on 12/5/14 4:49 pm

Dr Searles is my DR..I have Medicaid and they said yes..My operation is Jan 12th..did you get it?

Carey W.
on 9/26/15 6:02 am
RNY on 12/04/14

Sorry I didn't post I haven't logged on... no I did not they approved it for my insurance literally in January, my surgery was Jan 4th.  How are you doing?

mboyter5
on 7/12/15 3:52 pm - AK

I had full bypass done in 2011, and know what a pain it is to get insurance to even look at the requests. Keep talking to your primary care and call your insurance Co and have them give you a reason why and for a denial letter so you can appeal. 

I have gone through a lot to get what I have needed. The bypass was actually the easiest part , the problem came when the extra skin started causing problems such as migraines, hip and knee problems,ect... I also had a bad diasisis . All my Doctors agreed that the first step to fix this was to remove and fix the diasisis . My insurance said yes to half but not all the operation.  After calling them in tears they said that ,that half hadn't even been looked at . So they promised to put it through again.  When I called, I was told it was denied ,so I waited for proof, so I could appeal.  After a week I called again with the express reason to get the paperwork to appeal.  IT WAS NEVER PUT THROUGH The First time!  Within two days it was approved and I am now recovering from a Pandulectomy not sure how to spell it. 

Sorry this is so long but it is really important that you don't give up . My husband has a theory that they won't even loo****il you get serious.  I never got angry or blamed anyone for delays,  I just told the truth about not being able to walk and debilitating migraines.  

Never give up 

 

        
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