I'm very sad today

Jeanne T.
on 8/2/11 6:45 am
I called my ins. to see if I had been approved.  They said no.  I asked why and they stated that they did not cover the vsg.  That was a total surprise to me as I was told it was covered, that is why I proceeded with everything.  So I called the benefit specialist with my husband's employer and she is checking into it for me.  Anyway I'm very sad today, had my cry and now deciding what I want to do and how to proceed.  They said they do cover the gastric bypass and the band but I'm not sold on either one.  The sleeve was the best fit for me.  So I guess I'll see where I go from here.  Thanks for all the encouragement and I let you all know where I wind up.  There is a reason for everything so I know I'll feel better tomorrow and I'll keep on moving forward.

on 8/2/11 6:48 am - baldwinsville, NY
Oh my!! I am so sad to hear this news. I will keep you in my thoughts. Do not give up!!

I will say a prayer for you tnt Jeanne!!
on 8/2/11 6:55 am - Jacksonville, FL
I am so sorry to hear that. The same thing happened to a friend of mine who went ahead and did the lap band about 9 months ago and she has lost 60 pounds. She seems to be fine with the outcome. I am not sure that is what you are looking to hear but at least you do have two other options. Re-visit with your surgeon and maybe you will feel better about making a decision between the two.
on 8/2/11 7:20 am
Appeal, appeal, appeal!! Get your surgeon's office on board!


HW: 250 SW: 224 GW: 135 CW: 124

on 8/2/11 7:25 am - VA
Appeal! I was denied for a sleeve and eventually won. See my blog for info.

Who's your insurance company? What reason did they give for coving the band and RNY but not the sleeve? A number of companies are dragging their feet on covering VSG, but the excuses are usually flimsy and fairly easily rebutted in an appeal.
5'7"  VSG on 6/6/2011  HW 224, SW 214, CW 144  
on 8/2/11 8:18 am
Don't give up!!!!!

HW 310, SW 307, CW 259, LW 7.5, Goal 150

Shalom aleichem! Join us...  Keeping Kosher After WLS    
Ms. Poker Face
on 8/2/11 9:22 am
I agree about the appeal!  Several people on this board had your situation, appealed and won!  It may not be an easy process and may not result in approval, but totally worth a shot!!


5'5"    Goal reached, but fighting regain.  Back to Basics.
Start Weight 246    Goal Weight 160    Current Weight 183

Starting size: 22, 2x
Current size: 12, L


on 8/2/11 12:51 pm - Owosso, MI
 Appeal!!  So many have done so and won!  It can't hurt to try.  

Also, contact your state insurance board after gathering your facts about other insurance companies to see if your state board will get involved in the appeal.  

Good luck and DONT GIVE UP!  

"For God did not give us a spirit of timidity and fear but a spirit of power and love and self discipline."  2 Tim. 1:7     So with HIS power, love and self-discipline - I WILL DO THIS!
HW:250 SW: 232 CW: 164  GW: 150 
Jeanne T.
on 8/2/11 10:43 pm
Good Morning and thanks for the encouragement again. You are all wonderful.  My ins co. is CCStpa but they send their stuff to BCBS for approval.  So they are the ones who denied.   The reason they gave was investigative.  I think that means experimental but they don't want to say it.
Anyway I have a call into the ins worker at the clinic and I'll see what she says.  There was an appeal letter from some one months ago on here just wondering if anyone has any idea who it was.  Thanks again for the encouragement. 

Ms Shell
on 8/3/11 1:19 am - Hawthorne, CA
Since they approve other weight loss surgeries I have NO doubt that once you get the written denial and appeal you'll win!!

Much success to you!

"WLS is only for people who are ready to move past the "diet" mentality" ~Alison Brown
"WLS is not a Do-Over (repeat same mistakes = get a similar outcome.)  It is a Do-BETTER (make lifestyle changes you can continue forever.)" ~ Michele Vicara aka Eggface