Found out insurance may not cover sleeve

Emberbreeze
on 5/10/11 3:26 am, edited 5/10/11 3:27 am
VSG on 04/04/12
I had my first surgeon's appointment the other day and I found out I have to have a BMI of 50 or higher to be covered for a sleeve.  Right now i have a BMI of 47 and with the 6 month diet I'm sure it will be less in a few months.  I am covered for RNY, but I really don't like the idea of having so much rerouting of my insides.  I don't know what I'm going to do, except keep on doing the diet and see what happens.  My doctor says that he will appeal to have the sleeve after I have all the tests, but he doesn't know if they will approve it or not.  I'm at such a loss because I really want to be healthy and I am ready to have surgery as a tool to get there... but I believe the sleeve is a safer surgery and I'm not sure if I can go through with RNY :(
blessedladyh
on 5/10/11 3:42 am

I will be praying that you will be approved.  I started out wanting lapband but the more I read and research I really want the sleeve, but have not got an approval from the insurance just yet for that. My Dr office sent me an email today stating I have to meet with him first before they will send for approval and that appointment has not been scheduled yet. I have to complete the visit with the shrink which is tomorrow. so we shall see

    
GuineaPig2011
on 5/10/11 3:50 am
Call your insurance company and talk to them directly.  A friend of mine wanted the sleeve, she had her surgeons visit and they called her and told her the sleeve was not covered.  She called the insurance company directly and they said yes it is covered, but it had just been approved for coverage so all of the documents were not updated.  She asked them to call the doctors office back and they did.  She is just waiting for the final approval.
                
SassyItalian
on 5/10/11 4:58 am - Basseterre, St. Kitts and Nevis
Repost if want asking for appeal letters- many appeals to insurance for VSG are won with a first initial appeal.

There are several memebers on here who have appeal letters you can use as a template to appeal to insurance.

Dont take no for an answer, usually the first no is just a simple deterrent.

           
                       HW: 258lbs  SW: 240   CW: 140  I am 5 foot 7 and 30 years old               
                 VSG 12/21/10  Plastics: Tummy tuck, breast lift, and augmentation 11/3/11
                                             Soon to be veterinarian!! xoxo
                                                     

Emberbreeze
on 5/11/11 9:58 pm
VSG on 04/04/12
Thanks for all the advice. If the insurance company denies my request for the sleeve, I will definitely post for some templates for an appeal!! 
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