Hello,

My surgeon does the VSG for 11,000 and he's in Michigan and that includes hospital, anesthesia, 2 years follow up.

His name is Dr Mark Pleatman.

Goodluck

I am in a tight spot right now.  My insurance company requires a BMI of 50 to be considered for the VSG and that is the only surgery I am comfortable with getting.  As of right now I have a 48.5ish BMI and would need to gain about 10lbs to reach a 50 BMI.  The first surgeon I went to pretty much told me it's a waste of his time and energy to request insurance to cover a VSG if I don't have a 50 BMI and that if he did put it through he wouldn't appeal if it was denied.  So now i'm looking for a new surgeon, one that will at least try to get me the surgery I am most comfortable with and I am wondering if I should try to gain weight before my first weigh in with the new doctor so I can be covered.  I'm just stressed because I'm so close, yet so far away.  Has anyone had to deal with this before?

P.S. I have Carefirst BlueCross BlueShield of Maryland

I am just beginning the WLS process and have my first appt this week. I have Aetna, and am concerned about proving that I have had a BMI of over 40 for the past 2 years. I (like many obese people) have pretty much avoided the doctor for the past few years. I had my last visit to my gyn in Feb 2008 and then no other doc visits until Aug 2011. Anyone with any experience with Aetna have any ideas on how this might affect my approval? Any suggestions on where to go with the appeals process if I'm denied for this reason would be appreciated.  My BMI has certainly not been below 40 for the past several years--currently it is at 46 and has been for a while.

Thanks for any help! I'm a nervous nellie so I'm driving myself crazy with this. I know that the insurance coordinator will help me with some of this, but any BTDT stories would be great!

 has any one had A sleeve in va, if so  with what insur. 

Hi...

Had RNY back in 1/2010 and will eventually pursue some plastic surgery to repair my saggy body... but not expecting that I'll be able to get any insurance coverage for that. 

However, I've always had large breast and I still am wearing a 36DDD... and that's being 165 pounds and wearing a size 8/medium (I'm 5'9").  Since losing weight, it seems even harder to hold my chest up... and since I have arthritic vertebral changes in my lower back as well as some disc issues, my lower back doesn't flex enough to be able to pull my shoulders back enough to hold my chest up.

Long story short, my doctor a couple years back made a comment in my record that breast reduction could be in the future for me, but I haven't specifically talked to a doctor about it since my RNY.  Has anyone out there been successful getting a breast reduction paid for through Tricare?  What was required as documentation? What issues did you have to have in order for them to approve surgery?

Any thoughts would be appreciated... thanks.


tori