Insurance says no, so now what

After all the research, I chose VSG over RNY and the bands. Now Tricare has said no based on the surgery being unproven, (policy updated 8/18/11). Not sure how long a surgery has to work for them to move it to proven effective status since I believe the VSG is over 8 years of proven effectiveness.

So now I am faced with doing no surgery and trying to wait them out, or switching to RNY that I really don't want to be rerouted.

Anyone know how to start to get an insurance company to change it's mind?

The doc has offered to do RNY or band, but I am declining them at this point. Something needs to be done, but I was/am convinced VSG was the best option for me. Hate that it has to be an all or nothing decision.

Comments, support please.

Do what you feel will be right for you. I used Care Crdit becasue my isnsurance was stupid too!

Care credit by GE pays for VSG? Dang I could have had my surgery long ago!!! im on medicaid and started my journey in jan 2011 my surgery date is march 21 2012

It depend on what you qualify for. They only paid $5000 for me so i had to come up with the rest. It most likely depends on your credit how you will qualify and if you already have GE credit( I did) .

Who is your PCP? Are you enrolled at a local MTF? MTF's only do the sleeve and Tricare will pay for it. I had gone in for the RNY but my surgeon could not do it for other reasons and did the sleeve instead. Tricare paid the bill.

Tricare didn't pay for my sleeve the MTF I had my surgery did.

Tricare actually paid for your surgery. The MTF files with Tricare. If you are a dependent Tricare paid for the surgery.

 If you really want a VSG then you have two choices, wait till you are stationed somewhere that the MTF does it OR self-pay.  Tricare won't cover it until Medicare does.  It sucks I know.  I'm finally getting mine done in Bethesda.  Most of the large MTFs do it.  So your Hoods or Lewis obviously Bethesda if you aren't Army I don't know about AF and the others.

Not true.  Medicare does not cover the sleeve.  Tricare generally follows Medicare guidelines but they are not limited by Medicare.  Tricare only covers it at a MTF there are cir****tances dictating another procedure such as what happened to me..  Only dependents can get the sleeve at any MTF they are enrolled in. The army maybe a little different as there are differences between the different Tricare regions.  AF MTF's will not accept  refferal from a civilian PCP and Tricare will not let us go to a MTF unless we are enrolled at the MTF.

 I did think of another one.  Get a job at Starbucks!  Even part-time their insurance covers bariatric surgery.  Obviously you'll have to work there for a set time (I have no clue on the particulars) but it is an option.  Or finding any other job where the insurance would cover it.