So I've begun my pre OP appointments and just ran into ANOTHER huge hurdle. I called the hospitals office yesterday for a question, and was told that my insurance won't cover the sleeve. The way they explained it, was that 9/10 they say that if surgery is medically necessary, then to have the bypass.

So,I am pretty upset. If I go through with all the appointments, there is a likely chance I will just be denied anyways. I'm wondering if there is something the doctors can write in my letter that would make bypass a non option. I really do not want bypass.

So,I am just at a standstill and really bummed out. I wish I was told this weeks ago.

That sounds fishy. I'd get a copy of my insurance plan and read that for myself, just to be sure. 

I had VSG six weeks ago.

When I was researching benefits with my insurance...I was transferred to a case mgr that did the pre-authorizations approvals and she told me that they "rarely" approved VSG and that if they approved WLS for me I would probably be approved for bypass only. I was so worried.

But, when I met with my surgeon and told him this, he told me not to worry.  I take an oral medication for my lungs/heart and he advised that I would need VSG because of malabsorbtion issues that come with bypass.

If you are on any oral meds it might possibly be the same for you.

I would say don't settle and work with your surgeon to get approved for the surgery that you desire and what the surgeon feels would work best for you.

Good luck and best wishes.

~Sheri

If you have to take NSADs your can get approval sometimes as you can't take them with GB.

Any family history of arthritis, etc that you'd need NSAIDs ...get creative lol. Maybe if you have had low vitamins on labs you can

get your doc to say further malabsorption would be dangerous...

I have a family history of osteoporosis as well as cancer (most families do). The doctor wrote a letter to insurance company stating that Bypass was not an option due to not being able to scope floating stomach for cancer without an additional surgery and the fact that malabsorption of calcium could cause early onset of heriditary osteoporosis. Must have worked because I got sleeved in August.

Echoing another poster, you should see for yourself what is written in your own plan.  If you don't have it, call and ask for your summary plan document.

My doc's office didn't think I was going to qualify, because my BMI was just below 40, and many (if not most) plans require a BMI of 40 or greater.  I knew that my plan said I'd qualify with a BMI of 35 with comorbidities.  I faxed that page to the insurance person at the doctor's office, and approval went off without a hitch.  Your plan may list specific procedures, or be more generic about WLS.  See it for yourself, and start talking to the insurance person at the surgeon's office.  They are supposed to advocate for their patients, too.  Good luck!

Thanks for the replies! I am going to write down these ideas and bring them with me to my next appointment. There has to be something they can do to help. I had a good cry the other day, but I'm not ready to give up.

 

And I've been calling the insurance company, but I keep getting different answers each time I call. I asked for their policies regarding WLS in writing, and they said they would send the member handbook. Well, I read the handbook online and it only mentions bariatric surgery in one line. Silly people giving me the runaround!

You can often find the approval process spelled out in the policies for your particular insurance company online. Type in your insurance name with bariatric policies and search.