I'm SOOOOO upset!

For the past 2 years I've been on this journey to have bariatric surgery.  I originally wanted to be banded but some health issues prevented that from happening 2 years ago.  Well, I'm healthy again and decided it would be a good time to take care of my lifelong weight issues.

When I went for my initial consultation, my doctor told me that he would recommend that I have the VSG procedure.   I was initially against it but the more I spoke to him and the dietian, the more I liked what I was hearing.  I KNOW that they were aware of what my insurance was because one of the nurses came in to take my measurements and said that Blue Cross requires it as part of their process. 

I did my research and finally decided that I would go with the VSG.  The more I looked at the Lap Band, the more I felt that I didn't want to be banded after all (no offense to anyone who is banded, thank goodness we have the choices we do). 

This was not an easy decision but once I reached it, I was commited and excited!  I'm scheduled for my Psych Eval and Orientation on Tuesday.  After that, my case would be submitted to my insurance.  This was really happening!!!

Well, I called my doctor's office this morning to verify that they'd received my medical records from my General Practitioner (they had).  I was really excited because I was really getting closer to getting a surgery date.  Just before I hung, almost as an after thought I said, "So, do you think there will be any problem with Blue Cross approving my surgery?".  I almost fell off my chair when the Coordinator told me, "Oh no, Blue Cross does not approve VSG, they consider it experimental".  WHY WHY WHY in the world did they lift my hopes up only to have them come crashing down??????  I'm so angry and upset.  If I wasn't at work right now, I'd be in tears.

Please, anyone who is beginning this process, please find out at the onset if your insurance will cover your surgery of choice so that you are not dealt this kind of blow.

Thanks for listening . . .

I'm not well-versed in VGS (you may want to cross-post your story on their board).  However, I would suggest consulting with an attorney to file an appeal with your insurance company. If this is really the best option for you and there's enough medical documentation to support it you may have a chance to be approved.

I filed an appeal with the help of an attoryney who specializes in helping people getting approved for WLS.  You can contact him at www.obesitylaw.com Fill out thier form online and someone will contact you to discuss the case, they will tell you honestly if there's a possibilty of fighting them and winning.

DOn't give up, there's hope.

 Monica is right.  Do not give up hope.  I just got my 2nd denial from BXBS of IL, apparently they do not like how y MD crosses her "I"s and dots her "T"s!!!!  I am pursuing RNY and it is a covered benefit if they think you have jumped through the right hoops.  Presently my husband's HR department is pursuing the issue, but if they don't get results I have already contacted Obesitylaw.com.  They are professional and supportive.  

Good luck to you.

 Most insurance companies do not cover the VSG. It has not been done as a stand alone procedure long enough to have long term medical studies and reviews. That being said, there have been people who have been able to get the VSG approved by their insurance. I know with my insurance Health Net, they cover the VSG when a patient can not have the RNY or DS. But you'd have to have your surgeon prove that you can not have either of those procedures. 
Have you checked into getting the DS? The VSG is the first part of the DS, the second portion is the duodenal switch which offers malabsorption so that  you have restriction with the VSG but the malabsorption offers greater EWL and maintance. Since you have a smaller, yet fully functioning stomach you can still take NSAIDS, get endoscopes,  not worry about dumping, more variety of foods you're able to eat, you can eat and drink with meals, the list goes on and on.  Both the DS and RNY you have to take vitamins and supplements; you just have to take a bit more with the DS. The DS is covered by most insurance companies and is not considered experiemental or investigational. It is even covered by Medicare. Medicare does not cover the VSG though.  Check out the DS board.
It totally sucks that your surgeon would convince you to get a procedure that I'm sure they know is not widely covered by insurance. If you have your mind set on getting the VSG you could always self pay. Post this question on the insurance board and VSG board and see if anyone has your insurance who has been approved for the VSG, maybe they'll be able to tell you what you need to do. Best of luck and remember to research all your surgery options.

I also have Blue Cross Insurance.  I chose to have the DS.  And blue Cross covered my DS.  They would not cover the VSG.  I am having surgery Monday, and could not be happier with they surgery choice I made. 

Come to the VSG board. There are people there who have had their VSG approved by BCBS. It depends on which BCBS you have though and most of them had to appeal at least once.