WeekendWarrior

I started checking into the insurance today. I have Wellmark Bluecross and Blueshield. (I didn't know that BCBS is over 39 separate health insurance companies.) I gave them a call and asked them what type of bariatric surgeries they covered, and was told the following. Vertical-banded gastroplasty Adjustable gastric banding Gastric bypass (Roux-en-Y gastroenterostomy) Minibypass Sleeve gastrectomy Duodenal switch with a BMI of 50+ I hung up and thought great, they cover the VSG! Later I started thinking that I wanted to make sure this wasn't too good to be true, so I called them back and asked again, and wanted to know if they could send me the policy by mail or e-mail. This person told me that I could read it on the wellmark website, and gave me the following link. Bariatric Surgery for Morbid Obesity* Well I read the policy, and it looked like they would cover it, until I got to the very end, and noted. Sleeve gastrectomy as a stand alone procedure OR in combination with a malabsorptive procedure was considered investigational! Looks like I may have to fight them on this. Anyone know of a comprehensive list of Insurance companies that will cover VSG? I don't know if giving them a list showing that other insurance companies no longer consider it investigational will help. Any good resources out there on how to fight the insurance company? Should I just wait for my seminar, and ask the surgeon if they have gotten any BCBS insurances to cover it?

I have been looking at WLS for about 2 months now. I am currently 47 years old, 5 ft 7 and 315 pounds, BMI 49. This is the heaviest I've ever been. I was 140 pounds and 31 inch waist 30 years ago. Ive tried countless diets, and am pretty good about losing weight, but eventually gain it all back plus some. I went to an educational seminar about 2 weeks ago. The only 2 options they went over was Roux-en-Y Gastric Bypass (RNY) and the Band. I was really leaning towards the band, until I started reading a lot about it in the forums. It seems like a great option at first, but with the aftercare, fills, PBing, sliming, getting stuck, bandster hell, and long term complications like erosions and slips. it quickly dropped to last on my list. I really wasn't really gung ho about RNY as I have a couple of relatives that had that procedure. They initially lost a lot of weight, but seemed to gain back quite a bit 3 and 4 years down the road. I also didn't like the malabsorbtion part and the dumping syndrome. It seems like their pouches have a easier chance of stretching, and the blind stomach can be an issue as they can be prone to ulcers and it also produces ghrelin so they tend to get hungry more often. I then read about the Duodenal Switch (DS) this seemed like a much better option to me than the first two, but still had the malabsorbtion issues, chronic diarrhea and bad gas, and not many surgeons perform this operation. I then read about the Vertical Sleeve Gastrectomy (VSG). This seemed like the best option to me. I know to some the removal of a large portion of the stomach seems excessive, but to me if it kills the ghrelin gremlin then it's well worth it. One of the local hospitals in Des Moines Iowa have been offering VSG for a little over a year. I am scheduled for their educational seminar on Feb. 5th. I will be interested to find out how many VSG procedures they have done. They are a bariatric center of excellence. Anyone have a list of questions I should ask? I am going to contact my insurance to find out the specifics of which procedures they will cover.