insurance companys who approve gastric sleeve.

I am with UHC who currently deams the gastric sleeve "experimental', I am in the process of sending them a letter proving them wrong on there stamements in the policy.  I also want to show a list of insurance companies who are now covering this pocedure.  If youve had the sleeve and it was coverd or know of any that cover the sleeve. please share.

Thanks!

XX

The problem is that insurance companies don't have the most recent studies on the VSG which show great results at several years out. It usually takes 6-12 months or more from when the manuscript was submitted til when it is published. It then goes out to two or more reviewers who have about a month to submit their reviews (sometimes they drag their feet and need to be hounded to submit their reviews and could drag out the process). It is very rare that all the reviews and the Editor will say "this is perfect, just as it is." It usually goes through at least 1 revision, which has to be sent back out to the initial reviewers for approval (another month). Then, depending on the backlog, the Editor approves it and has to determine when the next issue ist hat has available space in it, which could be several months out. So researchers could have data collected from 2004, analyse the data, write the manuscript and submit it in 2004, and it could still be published in early 2006. So insurance companies could be looking at data from years ago (when they were still determining the best size to make the Sleeve, and many were made too big) They just aren't aware of the most recent numbers and research out there to make that judgement. Like in the Cigna link that Paul provided, they mentioned just a few studies, and we know there are a lot more than that, even some published after 2006. And they looked at it as a stand-alone and as part of the 2-part bypass with different popuations (regular MO and Super Obese high risk pts). The more recent research is very promising and very robust. It's showing wt loss almost as good as the RNY, and far better than the LapBand, over time. So I say, absolutely submit the research, as insurance companies can be too selective. Also, submit the proposal that is currently on the table to have ASBS to list is as an approved surgery based on the research which was submitted by dozens of surgeons internationally. Many people have gotten approved for the VSG, but it is usually on appeal. It could also be that some people had the medical reasons for the VSG, but some may have been approved based on the insurance company not aware of ALL the research. I know my surgeon's office says it sometimes has to send insurance companies research articles to debunk the "experimental" nomiker. But I know that someone got approved on appeal becasue they were able to demonstrate how many other insurances have ben approving the Sleeve, or at least that the same insurance comp had approved it for other patients. I know there is a link on VSGFAQ.com and one should have a list of insurances that the person had compiled. If it's not there, I'll try to track it down. The VSG forum could be helpful, if you ask about others who were approved with UHC. Good luck, Kahlua

Here’s a few links, and it seems UHC has approved it on a few occasions. Look for MarthaN’s post. You may want to PM her and ask about the details of who was approved through UHC since she mentioned she was aware of quite a few.

http://www.obesityhelp.com/forums/VSG/a,messageboard/action, replies/board_id,5463/cat_id,5063/topic_id,3342220/page,1/#2 5916231

http://www.obesityhelp.com/forums/VSG/board_id,5463/cat_id,5 063/topic_id,3445830/a,messageboard/action,replies/#26873870

Kahlua