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 

I went to a seminar for weight loss surgery present by DR, Srikanth at the Center for Weight Loss Excellence. I was really impressed and took all the paperwork to have ti submitted to the insurance for approval. I currently have asuris NW, reform 3000. They denied me but i have not followed up on why. Doctors office only told me they would not cover it. Has anyone experience anything with Asuris?

I am curious why they would nto cover it. I am 23, 365Lbs, at 6'. I have a very physical job and have noticed my abilities decreasing rapidly. I have tried numerous diets with no success. THe cost of not doing anything about it is going to be a lot more than the surgery.

Medicare coverage for VSG is currently under review, folks!  We may finally see VSG covered by Medicare by the end of June, 2012!  That should cause other insurers to move as well.

 

CMS, the Centers for Medicare and Medicaid Services, which really “is" Medicare, announced on 09/30/2011 that it’s soliciting comments on a proposal to cover laparoscopic sleeve gastrectomy (VSG) for Medicare patients.  The Public Comment Period is from 9/30/2011 - 10/30/2011. The Proposed Decision Due Date is 03/30/2012 with a final decision by 6/28/2012.  The big question appears to be availability & sufficiency of long-term data.

 

You can see the CMS Solicitation for Comments and read submitted comments at https://www.cms.gov/medicare-coverage-database/details/nca-t racking-sheet.aspx?NCAId=258&fromdb=true .

 

Also, in addition to the CMS info, the Internal Medicine News Digital Network reported that “A recent observational study presented at the annual meeting of the American Surgical Association found that at 1 year after surgery, LSG was associated with morbidity and effectiveness rates that fell between those of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y bypass procedures.

The absolute reduction in BMI at 1 year was smallest in the laparoscopic adjustable gastric banding group at about 6, greatest with open or laparoscopic Roux-en-Y gastric bypass at about 15, and intermediate at close to 12 with LSG.

The study, based on prospective, longitudinal, standardized data from 109 hospitals, was the first to come out of the ACS Bariatric Surgery Center Network accreditation program. Additional years of follow-up are planned, according to Dr. Matthew M. Hutter, an ACS Fellow with Massachusetts General Hospital, Boston."  (Source: http://www.internalmedicinenews.com/news/gastroenterology/si ngle-article/cms-considers-coverage-of-laparoscopic-sleeve-g astrectomy/fc3fe54035.html )

Harv