CIGNA DENIED VSG

As if I didn't expect this... Cigna denied my VSG :  "there is insufficient information showing benefits in large population, multi-center, and controlled clinical studies to support the effectiveness of VSG.  At present it is considered non-standard therapy, and falls under the category of experimental/investigational/unproven." My question is, do I appeal and send them every study I can find on VSG, or would a better approach be to switch my request to DS (the first part of which is a VSG) and probably get denied on that procedure for the same reason, but have a better chance a decision reversal for a DS rather than a VSG?  I read someone here appealled to Cigna for a DS and won, and I am wondering if that would have a better chance than trying to get them to cover a VSG, which is newer as a stand lone procedure, but has typically been done as the first part of the DS. thanks for any and all help, I am so dissapointed with the denial... Stefanie

Heres an option that looks viable but requires youir doctors involvement. Have them submit it as a TWO PART DS procedure. They can't make you come back for the second step, frankly it will be 6-12 months before the second procedure would be done anyway. If you don't feel the VSG is working for you you're already approved for the DS.  I actually had a surgeon say this was a brilliant idea, but enough do it they will eventually catch on. Also check VSGFAQ.COM for success stories on VSG insurance approvals. I am looking for the VSG also ann am planning on getting denied initially, I expect it to go to appeal initilally Good Luck

Stephanie, I am in the process of appealing the denial of my vsg for the same reason (although the wording was a bit different).  I sent them every study I could find, reasons that VSG was the best surgery for my medical issues (anemia and IBS).  I  know that the VSG has been approved by quite a few insurance comapnies on appeal.  My insurance actually stated there were no studies of two years or longer, so I was able to come up with quite a few that contradicted that statement. My surgeon had his "insurance girl" call the insurance com[any to see about the 2 part VSG and she told me they said I didn't "qualify"  I don't know if it is because my BMI wasn't high enough to necessitate it being done in 2 steps, or what...and that girl is no longer working at the surgeon's office, so I can't pin her down on that. There is information on VSGfaq.com for appealing vsg denial.  Pm me if you want what I sent out.  Marc (rawelch, I think) also sent me his info, which I tweaked for my cir****tances. Martha

Martha- thanks for the info (in this and my other post!).  I sent my surgeons insurance gal an email asking about switching the procedure to DS in an effort to win an appeal... we'll see what she says.  I am also going to call Cigna and ask some questions about their denial letter, to get specifics on some of the statements they made.

thanks so much!!!

Stefanie