Insurance says VGS is "experimental" - I am so sad :(

There are thousands of different BCBS policies around the country. They will add or delete anything, depending on what buyers want to pay.

They don't exclude WLS entirely, which is great for you. You stand a good chance of winning an appeal.

Challenge it, I too have Anthem Blue Cross and had no problem with it being approved. Also from talking to my surgeon who does both sleeve and rny, he stated he always prefers to do the sleeve because it's less invasive, and in his expert opinion, leaving the valve at the bottom of the stomach is important, you don't keep that valve with rny. Fight them.

Those policies are usually posted online so you can read it yourself.  Ask the insurance company for the URL.  If it is not online see if you have a benefit explanation book or ask them to send you one.  Also see what changes are going into effect in January.

My insurance denied me even though my BMI was morbidly obese. After my many appeals being denied, 2 1/2 years after my being initially denied, I self-paid for my VSG. Best decision I ever made. I am 10 months out today and have lost 88.4 pounds. 8.6 pounds more to lose to be a Normal BMI. Best decision ever, and best money spend (and I am not in any way wealthy). :-) Kay

Yeah, my insurance wouldn't pay for it either (they don't cover ANY bariatric procedures), so I had to pay for mine as well.  I considered it "an investment in myself."  Even though I'm only 5 weeks out, I think it was a good decision as well.  I'm down 33 pounds and am looking forward to getting to my goal, having a normal BMI and being healthy for many years down the road.

Appeal, appeal, appeal - to the state insurance regulators if necessary (and they should have an appeals process for those cases that can't be settled between the patient and insurance company.) Back when my wife had her DS, ten years ago, the insurance industry made the same claim about experimental/investigational. Once Medicare started covering the DS, that excuse was no longer sustainable. Check that avenue, but I believe that the VSG is now covered by Medicare, so that should torpedo the insurance company's excuse.

Hi really sorry to hear about your problem but all Dr. Consider this in the same degree as RNY 

Is this not covered by Ontario ohip  as the RNY is totally covered by Ontario  insurance. 

Also most insurance will cover if there is an underlying medical issue and your surgeon is best to talk to as I'm sure he has come across issues like this before.  

The also I've never heard that VSG is experimental as this surgery has been around for 20 yrs before the lap RNY. 

I wish you all the best luck but your surgeon would be the one to talk to as medical no to nsurance my help your cause.  

Good luck. 

sfayad 

Definitely challenge that. They are seriously behind the times and one of the last hold-outs in this area, and you may be the impetus they need to finally get on board.

That said, you'd likely do just as well with RNY as VSG. I wanted VSG for 3 years until my GERD excluded me, and I had a bit of an existential crisis coming to terms with the fact that I needed RNY instead. My husband had VSG 2 weeks later, and our post-surgery diets and processes have been almost identical. Either is a tool that will work if you pick it up and use it.

That's good to hear. I get a little more concerned about the horror stories I read about disease and organ failure because of malnutrition. How hard is it to really keep your vitamin levels normal? 

Have you had any challenges that he didn't have with the sleeve or vice versa?

i think the hardest part about this is the fact that I have been researching this surgery for about a year and I finally felt comfortable with it. I felt like the surgery itself and the lifestyle afterwards sounded like something I could do well with. I'm terrified of surgery, so it took me a long time to get to this place. Now I have to consider RNY but I don't know as much about it.

I hear you about the research! I scoured Medline for years, made my own Excel spreadsheets comparing short-term and long-term statistics between the two procedures, etc. My mind was completely made up, and I had to change course 3 months before my surgery date.

The vast majority (if not all) of the vitamin deficiency horror stories you read are from people who don't remain vigilant about their vitamins. You have to commit to taking them regularly for the rest of your life. But I was already doing that with my meds. I certainly didn't view my diabetes or blood pressure meds as optional, and I'd much rather be on a handful of over-the-counter vitamins than a handful (and syringe full) of diabetes meds. But some people fall off the "vitamin wagon," and that's when serious problems can happen. Also, failing to have regular blood work to see if you need to adjust dosages can get you in trouble. I'm only 6.5 months out, but I've already had to lower my B12 and change the type of iron I was taking based on lab results.

Interestingly, two of my coworkers had VSG last year, so I'm an RNY'er surrounded by sleeves, lol. I get reactive hypoglycemia if I overeat simple carbs or eat them in isolation. I've been learning what to avoid. My husband has thrown up a few times after eating too much post-VSG, and while I've been really uncomfortable the few times I've eaten too much or too fast, it's never made me throw up. My work BFF who had VSG does the same thing. She actually had a really rough recovery and had bad nausea for about 3 months post-op. I had nausea pre-op due to my GERD, but it was so well treated by RNY that for the first time in years, I'm not getting multiple nausea spells per day.

Also, all 3 recent sleevers I know had GERD issues develop after VSG, although they're all treated successfully with a PPI. In terms of food restrictions, besides the simple carb/RH issue I have, there's nothing my husband or I have tried that we can't tolerate, although I haven't added bread back yet just because it's a big trigger food for me. My work BFF is a year out from her VSG and still can't eat lettuce, shredded chicken, or some other meats. I read about some people having food intolerances after RNY too, but that seems to come down more to the individual than which surgery they had.