Insurance won't cover VSG, need help

Well I was turned down by MD-IPA for VSG surgery. They said that it was not medically necessary. My bmi is 43.3. I was told that over 40 you do not need co-morbidities for surgery, so I guess I have to start my appeals process. If anyone can help me with this please feel free to comment.

Have you tried the VSG forum for info? A lot of insurance companies consider it experimental or only in rare situations.

Do you know if they cover the DS? I don't know if you have looked into that option or not, but you may find the long term success rates better than the VSG.

Either way, I would not take this lying down. You will need to have your PCP and WLS surgeon willing to go to bat for you to document why it is medically neccessary.

If you are willing and able to pay, obesitylaw.com may be able to get that appeal in your favor quicker.

I would call your insurance and see just what WLS they cover, then go to your HR dept and make sure there are no exclusions

Is your MD-IPA  through your employer?  Are you a federal employee?  If so and your a federal employee you can appeal it to OPM   PM me if you need assistance if your a federal employee

Yes I am a federal firefighter under a federal plan and any help you can give me before the fight would be so graciously appreciated. Thanks so much for checking my problem out.

http://www.opm.gov/insure/08/brochures/pdf/73-100.pdf  this is how you need to proceed the fight. 

Basically M.D.IPA is denying the VSG as investigational per their medical policy see below

The gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch is unproven due to inadequate clinical evidence of safety and/or efficacy in published, peer-reviewed medical literature.


So you will need to follow the OPM guidelines to file appeal with MDIPA and when they again deny you then you file an appeal to OPM