X-Post: Question VSG vs DS, Insurance issues, what would you do?
In our opinion the only other option is the VSG. The band is not an option, as I had a failed band experience and don't recommend them, and no RNY as I worked at a bariatric clinic and know way too much about the "behind the scenes" things with that one.
When I needed a revision from the band, I wanted the VSG. Did the research and fought the insurance company and was denied at every turn for it. Yet they approved me for the Rny, and then when requested for the DS. I did the DS at a BMI of 53. Siince that time they have started approving the sleeve.
Well, I love my DS. I know I basically have the VSG stomach with the extra bonus of malabsorbtion. The stomach part is heaven when compared to the band, so I have no problem recommending that. But, I know how my hubby likes to eat and wonder if the restriction alone will be "good enough" for him.
My concerns are that he will not have adequate weight loss, and that it will stretch out and he will regain.
So now we have to decide to either quit, or "settle" for the VSG. I know I am posting this on both the boards, and I know that we are probably biased because of the choice we made, but if you had ONLY the choice of VSG or nothing... would you do it? And if you did have the VSG how do you lose weight and keep it off? (Low fat, low carb, low cal?)
I am so spoiled now with my DS, and I know how my DH likes to eat. It just does not seem that the VSG would be enough for him. He is wondering the same thing, so we are looking for some hopeful/helpful information.
Thank you in advance and please remember, I do not want to be flamed for the questions, I honestly need advice/help.
Thank you!
Band to DS revision 11/09/09.
Learn about the Duodenal Switch at dsfacts.com ! Off site comparisons of the 4 WLS
http://www.thinnertimes.com/weight-loss-surgery/wls-basics/w eight-loss-surgery-comparison.html
http://www.lapsf.com/weight-loss-surgeries.html
Am I missing something in your post? You say you fought your insurance company for your revision but now you sound like fighting is not an option for hubby. People have fought the < 50 BMI denial and won.. Please post the specifics of your insurance (company, policy-type, where administered) so those with successful appeal knowledge and/or experience can assist you...
Of course, your insurer won't see it that way, but that's what appeals are for. I share your concerns about the sleeve stretching out over time - longterm results for the sleeve are still unknown, though we do know that unless the sleeve is made very narrow, even the intermediate results will show weight regain by about 4-5 years post-op. And shortterm results are much like RNY, which is to say, not as good as the DS for either weight loss OR resolution of comorbidities.
MO is a chronic, lifelong medical problem. There is IMHO no rationale for an operation that only works shortterm, you need something that will continue working for the rest of your life.
Larra
FEP BCBS does cover DS. You don't have to be over 50 BMI. BCBS is confussed. They are probably looking at their local policy's which do say something about the 50 +BMI for DS but it does not restrict lower BMI from having it and the FEP Plan doesn't even mention the DS and 50 BMI in it at all.
Did you request this 'Federal' policy to be sent to you in writing? Because i don't think it excists. My insurance guru at my surgeons office was confussed as well because BCBS didn't have their crap together. FIGHT this! Believe me I am holding FEP policy in hand and it says nothing about this at all! I am calling my insurance tonight and asking for a manager and making them sign the Federal Policy and send it to me for proof. I have had several reps tell me just to follow the policy I have. I am having this same battle, stay strong and stick it to them!
I refuse to get anything other than the DS!
Here is a link to Fep BCBS 2011 Policy. Just go to this sight and scroll down and download the BCBS Service Benefit Plan.
http://www.fepblue.org/benefitplans/index.jsp
I bet if you looked up the BCBS policy in the state your having your surgery, it will say something about 50 + BMI but that is the local policy. They get it confussed with Fep policy a lot!
Here is a link to some atricles that might help you out......
http://www.dsfacts.com/articles.html
GOOD LUCK!!!!! You and your husband should fight for the DS!!!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**