Sleeve surgery, approved, by, insurance,?

This is what Priority Health says regarding VSG:

C. Limitations

1. The following bariatric procedures are covered when the surgical criteria

above have been met:

a. Roux-en-Y gastrojejunostomy

b. Laparoscopically Adjustable Banding with FDA approved device

c. Biliopancreatic Diversion with Duodenal Switch (BPD/DS) (For

Medicaid, see #6 below).

d. Sleeve gastrectomy IF one of the following applies (For Medicaid, see #6

below):

(i) A Roux-en-Y gastric bypass is contraindicated (e.g. severe

adhesions, previous bowel surgery) and the patient is either not

desirous of or not a candidate for any other covered procedure

(laparoscopically banded gastroplasty or biliopancreatic diversion

with duodenal switch ), OR

(ii) The sleeve gastrectomy is an integral part of another planned

covered procedure (i.e. duodenal switch procedure), but only if the

sleeve gastrectomy is performed because intraoperative

complications preclude the completion of the duodenal switch

procedure itself.

So I see the way around if the surgeon is willing - but holy crap! Why such a big ordeal for a surgery that's been around literally forever? heheh

Any advice on how I approach this with my surgeon?

Looks like how the surgeon words what he wants to do is the key...most docs are very accomodating...they want to get paid, they want to do the procedure, and they want you happy, because for stuff like this, youre the customer! Good luck!! Cali

yeah I'm the customer..problem is I'm in a pretty rural area and going with another surgery center would be quite difficult - having to miss work at least one day for every appointment, the drive time, money involved - its not something i have at this point and time.

Yeah, I know what you mean, I'm rural also. The closest doc that took my insurance was in LA which is 3 hours by Mapquest but double when theres traffic! Even though I am self pay I thought I want a relationship with a doc in my HMO because if theres trouble later, you know the insurance co would only want you to go to one of their guys! I am lucky I can afford to self pay but just the driving is really getting on my nerves.I wish you the best. Cali