WeekendWarrior

It's still considered investigational according to their current policy. Here's a link to their policy. Bariatric Surgery for Morbid Obesity* I have also heard they are currently reviewing their policy. I am hoping they join all of the other companies that are covering it. I am pretty sure they will as it saves them money in the long run. I started my 6 month diet last month. I am still unsure if a full 6 month supervised diet is required as I have had conflicting information. I've called wellmark 3 times and never get the same answer twice in a row. I did find a form the Dr. must fill out stating you have tried a supervised diet, but it doens't list any timeframe. http://www.wellmark.com/Provider/CommunicationAndResources/PDFs/P5341_PhysCertMorbidObesity_IA.pdf I haven't really decided on a surgeon yet either. I don't think anyone in the Des Moines area has done more than 12 last time I heard. I am thinking I would be much more comfortable with a surgeon who has a few hundred. I know quite a few people have gotten other BC/BS companies to approve if they need to take NSAIDS, so if they are still not approving it by the time I have my 6 month diet done, I will try and appeal and get it approved on that basis. Send me a PM if you hear anything!

Great news. Now if Wellmark BCBS can get off their butts and approve it. Here's a link to the Aetna policy. Obesity Surgery

Hope you are doing OK. Hopefully there isn't a lot of damage due to the earthquake.

Hopefully everyone is OK. I know several members were scheduled to arrive there today for surgery tommorow.

Here's the rules if you want to read them. Publication 502 (2009), Medical and Dental Expenses Since you are having surgery to prevent or cure obesity, then it is a valid expense.

I would think that it is always doctor ordered as the Dr. who did it thought it was medically necessary, or they wouldn't have done it.

I notice when I use the "New Posts" at the top, there is a 30 minute delay between when someone posts and when it shows up. Is this normal?

I guess I should update my Journey a bit. I have been kind of moving slow since my consult. I don?t know if it is because I am afraid of being denied. Or it maybe I am hoping that by the time I finish the 6 month diet, they will approve the sleeve and I won?t have to deal with deal with the appeal process. I am 99.9% sure they will deny me on the first try. I just turned in my release of information to my PCP yesterday. They need to send 3 years of records to the surgeon and get my psych evaluation before they will submit to the insurance company. I haven?t scheduled the psych evaluation yet either. When I talked to the receptionist to turn in my release form to my PCP, I told them to just send the records to me. I figured I could make copies, and keep a set for myself. That way if I decide to seek a 2nd consult, I?ll already have them. The receptionist was somewhat concerned about releasing the records to me. She said they might have to charge me for them if they release them to me, but don?t charge anything if it is being sent to a Dr. That makes no sense to me at all. The records lady is supposed to call me and discuss my options. I am also waffling on if I should go to another surgeon. There are not many sleeve surgeons in my area that I know of. The one I consulted (Dr. Lamasters) who has only done a dozen. She has done hundreds of RNY bypasses though. I don?t know if there is anyone in Iowa who has much experience at sleeves since hardly any insurance companies will pay for it. Kind of a catch 22. I don?t know if I should contact Dr. Gary J. Anthone, I know he is a highly regarded DS (duodenal switch) surgeon, so you would think he would be good at doing sleeves as he has 1600 DS surgeries. It also says he has done 250 Open VSG?s, and 25 VSG (I assume these were done Lap). My only concern is he may be great at Open, but are his LAP skills up to snuff? I think I also have concerns that they may try and talk me into getting a DS. I don?t really think I want to deal with the severe malabsorption issues. Ironically, my insurance company would pay for the DS. I have also been looking at appeal strategies. I think I have a good case that the VSG is the only acceptable WLS for me, since I take NSAIDS twice a day for my ruptured disc in my back, and my father died of stomach cancer. Once concern I have is that according to the WLS policy for wellmark BCBS, they state the following. ?Surgery for morbid obesity, also known as bariatric surgery is based on intestinal malabsorption and gastric reduction. Surgery is considered successful if weight loss is maintained at greater than or equal to 50% of excess body weight for more than 10 years.? Are they going to wait for 10 years before they approve the sleeve? Well I guess I should get off my butt, and schedule a psych evaluation and get the ball rolling. I won?t ever get anything done procrastinating. I suppose I can wait to choose a surgeon once I know i've jumped through my insurance hoops. Wish me luck!

Are you sure your company covers ANY weight loss surgery. Many companies don't buy the extra coverage for WLS. Have them send you your policy on WLS.

Well I had my consult with the surgeon today. She agreed that the sleeve was probably my best/only option with my nsaid use and history of stomach cancer in my family. They told me to continue seeing my PCP to document my weight as many insurances pull the physician assisted diet requirement even though there is no mention of it in the policy. They gave me a checklist and I was able to check off 2/3rds of it already. I still need to get the psych exam. Maybe I'll get lucky and they will change their policy by the time I get through jumping through all the hoops. So I guess it's wait time to see when I get my first reject letter.

Well tommorow morning is my first consult with the surgeon. Then I supposed the games with the insurance company will begin. Hopefully I can convince them that the sleeve is the only option for me. I could gain a little more weight and qualify for a DS, but not sure I want to. Not sure how well the malabsorbtion will be when your elderly. The sleeve just seems to be the most logical choice for me.

I have been reading quite a lot, and see many posts on vitamins, protein powders and the like, but haven?t really come across much on how much people actually spend on them. Can anyone give me an idea on how much they spent on these things for the first year, and then longer term? I?ve read the Duodenal Switch Forum (DS) on obesityhelp (OH), and they seem to average somewhere around $100.00 a month. Some spend a lot more, and a few seem to get by on $30.00 a month. I know they tend to have to take a lot more than sleevers due to the malabsorbtion.

Here's a link to a review of a bunch of studies on VSG. There is a table with bougie sizes, though some of them don't list one. Click here for link I think most of it depends on the individual, and how much weight they have to loose. Most of the ones that seem to have issues with VSG start with a very high BMI of 60 or more. I think the lower your starting BMI, the "easier" it is. The sleeve makes it easier to be successful, and prevents you from eating a ton of food very quickly. I've also seen that there are people that can eat around any type of WLS currently out there. If you are going to sit there and slowly eat a 5 pound bag of M&M's every day, you are going to fail. You have to stick to the dietary guidelines to be really successful.

There is another post with pictures of pens representing bougie sizes. A sharpie pen is about a 36/40 size. Click this Link

Nothing like fresh pork rinds you get off a hog when your having a whole hog roast. YUUUMMY!

I feel for you! I think I am having the same issue. If I walk or stand more than 5 minutes, my right hip starts to hurt progressively worse and worse. It gets so bad it feels like someone is dislocating my hip. It also radiates down my right leg, and my big toe goes completly numb. I also get numbness in both legs when I lay on my back at night, so It makes it hard to sleep. I had 2 steroid injections into my spine a couple months a part. The first one lasted a few weeks, and the second didn't seem to do much at all. I've had xrays, and they said nothing was wrong. I had an MRI and they found a protruding disc. I've been to surgeons, but they all say I am too heavy to operate on. This is what got me looking at WLS. I currently take nsaids, which help some, but I can't take strong muscle relaxers or pain pills and work, as they make me too sleepy. I have noticed that when I go to the dentist, and they raise my feet above my head, the partial inversion seems to take a lot of the weight off. I don't know if traction would help at all. I am kind of in limbo right now. I see a VSG surgeon on the 23rd. I know my insurance company considers it investigational, so it will probably deny. I don't know if I can wait long enough to fight them, I hope I would be able to appeal on the grounds of my nsaid use. If I gain 10 or so pounds, I would qualify for the duodenal switch, BMI of 50. I don't really want that extreme of a malabsorption though. I really can't afford to go to MX at the present. I hope you find some relief soon, and if you do, send some my way will ya!

From what I've read, the lower your starting BMI, the better the VSG works.

I remember seeing something about a baruim swallow leak test also. I googled it and found Dr. Guillermo Alvarez Dr. Guillermo Alvarez: Gastric Sleeve (VSG) & Lap-Band® Not sure why they would use barium for a leak test when it seems to be contradicted in the case of a leak? Oversewing the staple line is supposed to strengthen and prevent leaks. Found a study that gives some conflicting data. (Link) Looks like some use a buttressing material, and some may use a fibrin glue, or a combination of all of the above. Am I reading the following right? a 42.6 percent leak rate when using a buttress material? A review of sleeve gastrectomies in Germany[22] demonstrated a leak rate of seven percent in 144 patients and 42.6 percent in patients who had a buttress material employed with the staple line. Uglioni et al[23] reviewed 74 patients who had their staple line oversewn. There were no leaks, although one patient had dysphagia caused by excessive narrowing of the tube due to oversewing.

I got the same connecting issue last night also, but it appears to be working this morning.

Does anyone know of a list that shows what insurance companies cover VSG? If not, should we make one and get it made a sticky? I would like to see a list of Companies, and a link to their obesity insurance policy, whether it is covered, or considered investigational, and if anyone has successfully appealed? I would think a comprehensive list of companies that do cover it would be good for people appealing a denial. Maybe this is just too big a task? Here?s Mine Wellmark Blue Cross and Blue Shield as of 2/1/2010 http://www.wellmark.com/ Current Policy VSG is considered investigational. http://www.wellmark.com/Provider/MedPoliciesAndAuthorizations/MedicalPolicies/Policies/obesity_surgery.aspx Know cases who have appealed None known at this time.

I think this may be the link to your policy. "The investigational status of these procedures is based on the judgment that there is insufficient evidence to demonstrate that the increased risks of these procedures, compared specifically to the gastric bypass with the Roux-en-Y procedure, are outweighed by a significantly greater reduction in obesity-related morbidities and excess weight loss" I think you may be able to disprove that the VSG is riskier than RNY. There is an update positon by the ASMBS (link) Here's a thread with an appeal and references (link) I don't know if a list of companies that no longer consider it investigational whould help (this is the reason I started this thread). I believe Kaiser, and UHC both cover it now. I also found a thread on appealing. (link) According to this, you have a great chance of winning an appeal in california. I don't know if we have the same sort of appeal in Iowa. Hopefully some of the other vets here can chime in with more information, I am a newbie here, and just started looking at WLS. I wish you great luck in your appeal process, and don't give up!

Not sure where you are getting your surgery, but if it is local, you can ask your Dr. if they have any samples. The surgeon I am going to see has lots of sample packs they get from the various companies. You also might check to see if there is a local WLS support group. We have one in my area and they do samplings after the meetings each month. I have also read quite a few posts where your taste can change after the surgery, and something you like now you may hate in the future, so I would probably NOT purchase anything in large lots until later down the road.

Is this ASMBS position paper the lastest? http://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf