Insurance DENIAL

Yes...thank you....I wont give up. The doctor seems to be very nice and so had the insurance lady until today....she told me not to be optimistic...who says that?  I thought that was harsh considering her position and her knowing my situation. I was only calling to give her info the insurance company had given to me and her attitude was horrible....since I am already in the process with them I am going to go thru the motions but if things does not go the way I think they should than I will seek another doctor and start the process all over again.

I was denied back in 2001... yep, that long ago, back when RNY was the 'gold standard' (some may argue it still is).  Appeal did NOT work as it wasn't the insurance choice, it was my husband's employer who decided against covering bariatric procedures/diets/anything.

I am just now getting insurance which will cover the VSG through my own employer.  Had my new insurance not covered, I would've been on a plane to Mexico by now.  I, too, would've chosen Dr. Alvarez.  He has plenty of happy patients on this site and others, and his videos and website are very informative.  If I were to take the risk of going out of country, I would risk it with him.   http://endobariatric.com/

After 10 years of denials, I'm tired of the fat, and tired of the fight.  Hope you don't have to wait that long!  Especially since it's more affordable than ever, both in the states, and out.   

I was denied. My insurance said they will not cover any type of WLS even though I have sleep apnea and am pre-diabetic. I am instead going self-pay using Dr Ortiz out of Mexico.
Good luck. I hope your appeal goes through. If not, consider Mexico/self-pay.
Many people say the care is better than in the US. The Dr I am using is in the top 15 of Bariatric Surgeons.

Im just curious to know how does that process work when going out of the country for the surgery? Are there any pre-op requirements?

For Pre-Op, I had to complete a long questionaire regarding my current health and health history, and from that I was cleared for surgery. I have to do a 9 day liquid diet before hand. I also have to use a spirometer to strengthen my lungs every day prior to surgery.

I noticed your vsg date is 2/29/12 so you havent gone yet....how long is your stay there?

I  am flying down a day early, 2/28 and will stay in a hotel. I will have my surgery the next day and stay overnight in the hospital. The following 2 nights, I will stay in the hotel again and fly home early on 3/3.

I too am going out of the country for my sleeve, and I know that I have made the right decision for me.

Like Denise, I will be flying out to my surgeon the day before surgery for preop testing. I will be staying in a hotel that night, and then surgery the next morning and staying in the hospital for three nights, then flying home the next day.

There are a lot of great surgeons just across the border. If you think you are interested in going that route, I suggest you call a few of their offices and ask questions, and see who you think will work best for you.

My insurance will cover a lap band or a RNY 100%, but they won't cover the sleeve unless you have a BMI of 50 or above, which I don't.  But out of the three WLS's, the sleeve would be my first choice.   My surgeons office just turned in the paper work for a sleeve, and now I'm waiting for a denial so I can appeal.  My surgeon said something about him having a peer interview with one of the physicians from the insurance company.  I so hope it works...  

Good luck to you!!!!

 YES, appeal their decision and don't give up!  I won on my second appeal with the help from an atty!  Best of luck to you!