Advice needed!!!

So I'm scheduled to meet with my surgeon tomorrow for the first time. I work for the hospital in which I am planning on having the VSG. So I schedule all incoming people for their preop nutrition classes and support groups. I have had my heart set on VSG...I have done tons of research and know this is what I want. I spoke to the girl who works with the surgeon today to see if she could get me the codes to call my insurance to make sure the sleeve is covered and she tells me that you have to have a BMI of over 50 for the sleeve to be covered!!! I'm at a 43. Yet lap band and RNY are covered no problem.  I felt like someone punched me in the stomach and knocked the air out of me..to say the least. So I called my insurance company...BCBS and spoke to someone and she told me that it states a BMI of 40 or 35 with other health issues. So I'm not going to say anything to her...I'm going to wait till I see the doctor tomorrow and see what he says. But I just feel at a loss right now. Any suggestions. Sorry this is so long..I'm just stunned and sad.

 

Sounds like the person you spoke to in-house didn't know the specifics of your particular plan and was just going off of generalizations.  If the insurance rep said differently, go with what they said... they are more knowledgeable about your specific plan than someone who deals with hundreds of different plans a day. The insurance co said BMI of 40 is okay, and yours is 43... not sure I see why you are upset? 

Sounds like you are well on your way to having your insurance cover this.  Good luck!

I have BCBS-IL and a BMI of 41 and I was approved for the sleeve.  Surgery will be on 10/30/12.
So there is hope that your BCBS will approve it even if you are under 50 BMI.
:)

I'm going to wait and see what the doctor says and if he says that it's for insurance purposes than I'll get it in writing what they told me. I've just heard and seen so many people that are told one thing by the doctors office and several different things by the ins companies and be let down. Thanks for your advice!!!

All insurance is different, but I have BCBS of IL and it is covered for 40 or 35 with comids. Perhaps she was thinking of the DS? My policy states 50 or higher for the DS.

I would simply tell her that you called to verify your coverage and that is the info they gave you. Also, you can find the medical policy online at their website. I am guessing your BCBS might be setup diff than IL, but if you want to know the area to look for that, I can try to help, let me know.

Good luck! 

Thanks Amy...I went to the website and there is no search or anything. It just gave me basic info on my policy..nothing about coverage or what is covered. I even asked the rep on the phone if I could find what she told me in writing and she said no. I WILL get it in writing if I have to. If you know another way I can find it on line please let me know. Thanks again!!

 I have BCBSIL and BMI of 39. I was not approved for VSG even with an appeal. We submitted for RNY and was approved right away. With BMI under 40, comorbididies were necessary for approval. 
Why? Not sure.