BCBS Fed Questions

Hello,
I've been lurking for a while, but have found this site to have so much valuable information and support.  It seems everytime I have a question, someone is already asking it and is receiving quite a bit of great advice. 

I had been considering lap band and met with the surgeon, but have to conduct the required three month doctor supervised diet.  I'm almost finished with this portion.  In the meantime I've been reconsidering my decision to have the lap band surgery and am looking into the VSG.  I live approximately 3.5 hours from the surgeon and the lap band maintenence would have been more than I can manage due to a very busy career.

I am meeting again with the surgeon in a couple of weeks to discuss VSG which he does have as one of his surgery options.  In the meantime I talked with BCBS Fed to see if they cover VSG.  They had a representative call me back and left a message stating that they have never heard of VSG and that it would need to be a FDA approved procedure.  They also said that it was unlikely that this would be an approved and covered procedure by BCBS Fed.  Does anyone know if VSG is an approved procedure by the FDA?  And if anyone who has BCBS Fed had a response such as this?

Thanks!

I have BCBS Federal and VSG is a covered procedure.  I would call BCBS Federal and ask for a different representative.  There are over 6 employees at our federal agency that had VSG procedure covered by BCBS.

Thanks!
I was wondering if I should call them back since I was not able to discuss this with them personally.

If that does not work.  Speak to the doctor's office and ask for the Diagnosis Codes and CPT codes for the VSG procedure.  Then call BCBS feb back and give them those codes.  Sometimes representative only speak code. :)   I've included the link to the 2011 BCBS handbook below.  Page 53.

http://www.fepblue.org/benefitplans/2011-sbp/bcbs-2011-RI71-005.pdf

Good suggestion, I'll do that.

There seem to be regional differences in BCBS-FEP depending on who's managing the plan.  But, yes, it is covered.  Here in Texas, it's approved as a matter of course.  Other places, some folks haven't had any problems; other places, they've had to argue with the insurer or file an appeal.

It's a relief to know that it is covered, I just hope that I don't have to mess with denials and appeals.

I too had vascillated between the lap band and the VSG.  I consulted with my Dr. I told him that I wanted him to give me the pros and cons of both procedures.  We also disucssed some of the medical issues I have been having and he believed that VSG would be the best for me. Im so happy I did the VSG.  My coworker had the lap band a few months before me and I have already surpassed her weight loss.  Also, she gets a lot of food stuck on a pretty consistent basis.  Ive just hit my 6 week mark and ive only gotten food stuck 2x.  I feel great!

Regarding your insurance issues, I have Horizon BCBS of NJ and they had no prob covering my procedure-- so good luck with the pepole of Blue Cross and Blue Sheild.  Just keep pushing!

Good luck!

From everything I'm reading, there are people who are successfull with the Lap Band, but there are also people who are not so successful and they sometimes develop other issues.  When I read this forum, I see far more people who are having success with this procedure and are not having near as many issues.  

I think once I get the insurance taken care of then I can concentrate on the procedure and make plans.  I appreciate all the great advice and support!

I'm retired, however, we're still covered by federal health care -CareFirst/Blue Cross in MD. (we have Medicare Part B also).  So my VSG was covered by both - BC paid the Dr. bills, Medicare paid the hospital.  I paid $97 w/my 3% senior discount.
You are right to consult and consider all options when looking at WLS.  I'm obviously going to advocate for the VSG since I've lost 133 lbs. in less than 6 mos. - That said, I began this journey at 425 lbs. - super-morbid-obese, and looking to lose a min. of 175 - others have much less to lose and opt for lap-band as a preferable option. 
VSG requires a committment to a life-style change that is significant - and it is forever, although maintenance is much more "normal" than w/ bipass surgery.  Approaching 6 mos. post-op, I'm feeling great, esp. since I've lost diabetes, high blood pressure, sleep apnea and lethargy in addition to all the weight.  I still have 40+ lbs. to lose, but I know that will happen.  Good luck as you continue to investigate your options. 
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