My insurance doesn't cover the sleeve!

strawberryblondie
on 3/25/11 1:31 am - Virginia Beach, VA

I just found out that my insurance does not cover the Vertical Gastric Sleeve. I had my heart set on this particular surgery and now I am very disappointed. I can still have the Gastric Bypass surgery, but I'm unsure if I should wait an see if my insurance will cover it in the future, or move forward with the bypass. Please help! I am new to this forum and would appreciate any input!!

First visit with surgeon                            3/17/11
Cleared for surgery                                 4/29/11
Approved by insurance                            5/10/11
Surgery Date                                            5/24/11

Fran-I Am
on 3/25/11 2:24 am

DS on 10/12/11

Sorry that your insurance does not cover your first choice WLS. I would not settle for a WLS that you do not want. Does your insurance pay for the Duodenal Switch (DS)?

bubbylucy
on 3/25/11 2:34 am - Raleigh, NC

RNY on 12/14/09

The VSG was originally created as the 1st step in a two step procedure for the super morbidly obeses BMI over 50, the second step would have been the duodenal switch. Insurance has fought to not cover this and will probably be a long way down the road if they ever change thier minds. You appear to only need to lose 75 pounds, so the RNY is a good option for you. I would not do it if you feel like it is not for you. I am just saying it is a good option.

Good luck
Audra

steve D.
on 3/25/11 2:46 am - West Fargo, ND

It is not that uncommon that VSG is not yet covered. I think doctors will move that direction, but are in some ways hampered by insurance companies who are waiting to see what results are like before they cover it cart blanche.

You always have the option of self-pay if you could afford it. I could not have. The question is, can you afford to wait?

Steve

(deactivated member)
on 3/25/11 3:23 am

VSG on 06/30/09

You can appeal their decision. Many have and won their appeals. I would post this on the VSG board and ask for help. People will gladly show you their successful appeal letters. Good luck. I personally would not get a surgery I did not want 100%. You will have to live with this choice for the rest of your life. Fight for it or save the $10,000 and self pay. I self paid for mine and it's worth every penny and then some. I love my new life.

Mrs.M
on 3/25/11 3:34 am

RNY on 09/30/10

My insurance didn't cover the sleeve either. But my surgeon recommended RNY anyway because he felt a simply restrictive procedure would not be successful for me. Lapband wasn't successful so I had the revision to RNY in September and it has been the best decision I have ever made, short of marrying my husband! The only thing I have found to be difficult is remembering to take all my vitamins. Definittely a fair trade for 62 pound loss so far.
Janet

walterswife
on 3/25/11 4:50 am

RNY on 12/22/09

Unfortunately many companies do not cover the sleeve because they consider it experimental. It was not an option for me because of that. Therefore, I never considered it.

Someone has suggested that you consider an appeal. That sounds like a good option.

There is no telling how long it will take your company to change its position about whether the procedure will be covered.

I hope you are able to get the surgery that you feel will be best for you.

HW 240/ SW 229/ GW 146/CW 125; OH Support Group Leader

Starting size: 18W-20; Present size: 0 or 2; 5'5-1/2" tall.
Current BMI 20.4 as of 2/13/2013 (normal for the first time in my life).
Goal weight reached on 8/12/2010; As of 1/13/2013, 21 pounds below goal

Elizabeth N.
on 3/25/11 5:17 am - Burlington County, NJ

DS on 12/04/06

I'm sorry you got this news. I felt so strongly about the superiority of the DS for me that I paid cash for it and traveled rather than to get the RNY done 15 minutes from home and covered by insurance. There are ways to reach your goals. It might take a while and you might need to think outside the conventional boxes.

LittleMissSunshine
on 3/25/11 6:21 am

VSG on 05/23/11

Would your insurance cover the DS? If they would, you could request the 2 stage approach, the first part of which is the VSG. Then when it comes time to do the 2nd stage, if you're happy with where you are and don't feel you need to do it, don't... you'll just have the VSG :-).

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Emily F.
on 3/25/11 8:38 am

DS on 04/05/10

Keep researching, I wouldn't get something I didn't want. I flew to another country and self paid to get the surgery I wanted.

My insurance doesn't cover the sleeve!

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My insurance doesn't cover the sleeve!