What do insurance compaines THINK!!!!!

kim_in_alabama
on 4/12/11 2:53 am
 OK this is a little of my own fault.   Tri-care pays for lab-band, RNY, stomach  stapling VBG.  But NOT and I repeat NOT VSG (only if done at a military hospital).  I live in BFE....  Okay that is fine. 
  I had my heart set on Lap band and then VSG, but not covered so I looked into Stapling or VBG, rarely done anymore because the advancement of the others.  So why would you approved something that is basically obsolete?  Common sense.would come into play here at some point in time.  
  I am going back to the band, I used to workout all the time years ago, I just need  a little push to make workout my main goal again.   They also do revisions if something doesn't work for you or the you have problems.  WHAT????? 
 I say approve them all and let the doctor who know what would be the best for you recommend which one to have.    But I'm glad they have lapband on the table. 

Thanks for listening to my RANT.... I've been on a roll today, co-works have been getting it and everything.  Better out then in I say.  Thae's when you get ulcers.
   
HW:306  SW:291  CW: 265  GW:165      
Hermosa L
on 4/12/11 3:01 am

I'm curious if you considered stapling why not consider RNY?

I'm not saying you won't be successful with the band I'm just curious why RNY is not viable option for you?

RNY was very expensive my insurance didn't cover much the same with lapband but the lapband wasn't as expensive (out of pocket expense for me)...

I wanted to make sure I learned how to eat differently change my lifestyle and my approach to food.. I have people around me who had RNY and lose a ton of weight but didn't change their behaviors and have gained some weight back... that is why I choose the band...

Anyhow those were my reasons with going ahead with the band vs RNY..
 

grannymedic1
on 4/12/11 3:04 am - Lake Odessa, MI
Revision on 08/21/12
I understand your frustration with insurance. Don't get me started. None of it makes sense to me. I know you live a distance, but if you really want vsg I would do what ever it takes, including the trip to a military hospital (I know about them, too) in order to get it. Honestly, while I love my band I never advocate anyone "settling".

Good luck with it, Sue

                    

Highest weight: 212.8 Current weight 135 Lost 77.8 pounds

    

Lisa O.
on 4/12/11 3:07 am - Snoqualmie, WA
The VSG is not approved yet by many insurances because it's still fairly new as far as the WL surgeries go, less than 4 years, I think and is considered experiemental.  More and more insurances are starting to cover it though.

Just make sure you are doing all your research, because the band requires more maintenence over time and you need to do some of the work in controlling portion control and the type of foods you can eat.  It takes a lot more than exercising, although that is definately a big part of the process.

Good luck in your surgery search!

Lisa O.

Lap Band surgery Nov. 2008, SW 335. Lost 116 lbs.  LB removal May 2013 gained 53 lbs. Revisied to RNY October 14, 2013, new SW 275.

    

    

Thundergrrrl
on 4/12/11 6:01 am
You can always apply and get the official denial letter and then appeal. Lots of times they just make you do that so they can deny as many people as possible (most won't appeal.)


Highest Wt: 274 / LAP-Band Low: 180 / Sleeved at 233 / Goal: 160!

LittleMissSunshine
on 4/12/11 7:48 am
Agreed... post on the Revision board and see if anyone can offer advice on appeal success with plans that won't cover the VSG.  More and more plans are coming on board with it, so definitely research as much as you can.

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