No Sleeve for me, need two knees - not happy- long

My goodness, you have a lot on your plate! I don't have any specific feedback to offer that the other posters haven't already covered, but my heart goes out to you.

I am sorry, I was just trying to help think of some way that would help you get the surgery. I know that you said the insurance co. said you would never win an appeal, but why not try anyway? I would never take their word for it. Why don't you come to the DS forum and ask Dianna Cox about appealing? She is absolutely amazing when it comes to wording appeals and who to talk to (the state organizations that oversee insurance co's).

It wouldn't hurt to try, and what do you have to lose?

No need to be sorry - I appreciate all the suggestions.  I will check with Dianna - thanks.

Since it is not the insurance company, but your employer that excludes it, perhaps it is to HR that you need to appeal, ask them to make an exception based on your medical necessity.

But, I agree. Speak with Diana Cox about this.

Best of luck to you!

 After reading your post, I decided to join. Just because the insurance booklet says no VSG, it does not necessarily mean that is their policy. Our BC/BS booklet says no, but our surgeon said ins had agree to cover in specific cases-i.e. on blood thinners. My husband submitted forms in October and had surgery in November. My health history is similar to yours. I submitted ins pre-approval in May and was denied. I called they said appeal chance is zero, I asked why a family member was approved (Didn't say it was husband) and an hour later said well there are some cases approved. The initial request was 280 pages; my appeal was 320 pages. The appeal was approved.

My advise, call the insurance monthly and ask if the insurance has been approved for VSG for specific health issues. Ask the name of the person you are talking with. Why monthly, they do not send our notices of change of coverage. The booklet information may not be up to date.

was just wondering why you had to wait five years for medacare average weight time is 2. with your health problems you should be eligable for medacare and disability. and i know in michigan if you have cancer your disability is approved in a few months. i dont understand why you have to weight so long for medacare please keep trying on this. I am a disability 38 year old got disability in 6 months for fibro and ms. They said i had to be on disability for two years before medacare but was only on it about a year and a half and medacare kicked in. can right id need help ive gotten pretty good at on line stuff with ss

not if she has not worked.  Medicare and disability are based on the person's work record....

she did work, but she has to have work within ten years of her fileing date, she may have let it lapes, one should never stop working b4 age 55 or they can find themselve in a dead period of no coverage such as her between her last work and reg medicare coverage at 65. 
  If she files promply they maybe able to go retro a bit and she will get medicare under the wire of her ten year cut off. as a disabled person

My mother had both knees replaced when she was 60+.  She went to rehab facility for 2 - 3 weeks.  Recovery is not easy, surgery is painful,  but in the end she is much better off.

Medicare covers WLS.  If you were on disability,  Medicare would cover it.  Otherwise,  in 5 years you can get it covered.

While I understand that many insurances won't pay for weight loss surgery, for weight loss, I have often wondered if they would not pay for the procedure if it were linked to some sort of medical condition? 

For example, and I'll use something very extreme to make the point, let's say you had a condition that was causing you to have little strokes and the only way to cure or manage that condition was a gastric bypass?  At that point gastric bypass would be medically necessary; consequently, would the insurance company not be under obligation to provide the procedure as a means of saving life?

Don't really know where I'm going with this, but just wondering if the doctor appealed to the insurance company, stating that gastric bypass or whatever was medically necessary to save your life, would the procedure possibly be covered at that point?