Kelkie

I have BCBS North Dakota PPO as well, even though I live in Oregon. I was denied the first time, but approved on first appeal. Good luck. If you get denied the first time, don't give up.

They told me to expect a 2 week wait. I called them after 1 and it had been denied already. My appeal took about 3 weeks from the time the insurance company recieved it to the day my surgeon's office got the approval. The wait sucks, but once you have an answer either way and can move on to the next step, it gets better.

I am happy for you making this decision! Good luck.

I was denied the first time because my insurance company considers the surgery "investigational".

I would be happy to share...afterall, I wrote my own letter, but used references from a couple of letters that I found on here, and over at OH. PM me your email info, and I will help you out as much as I can.

Thanks everyone! I am so excited I just don't know what to do with myself... I couldn't eat dinner (note to self: do not check email prior to dinner), I can't sleep either... Wow

I got approved through BCBS of North Dakota on first appeal! They sent it out to an external reviewer, and they said yes!!:scared0: I am soooo stoked! So, everyone who is denied the first time... fight back! It is possible.

If your insurance doesn't cover bariatric surgery, its because your employer (or whoever provides the insurance to you) has excluded it from their plan. You could try to appeal to your human resource department and find out if they can make any exceptions. Other than that as far as insurance goes, the company is limited by the plan that was purchased. There are companies out there that will lend money for surgery, one of them is Care Credit. You could also try a credit union, or just call around to dr.'s offices and see what you find out. Good luck. I know how frustrating it is.

Thank you for responding, minime... I agree with you, and that is why I was confused. I can only assume that the internal review team felt they could not make a decision. According to member services, a nurse looked at it first, then it went to the appeals review department, and now external review. Hopefully they will concur with me and my surgeon.

My surgeon's office submitted all my paperwork for VSG to BCBS North Dakota. A week later it was denied. As soon as I got the letter, I faxed my appeal letter with many references to the surgeon's office, they resent all of the information, with a new letter from the surgeon. BCBS has had the appeal for 2 weeks, so I called them yesterday. The nice lady in member services told me it had been reviewed by their dr. in the appeals dept., but they sent it to an external reviewer for another opinion. Does anyone know what that means? I am encouraged that they seem to actually be looking at it, and didn't just immediately say no...I hate waiting!

The other code is 43843-A gastric restrictive surgery without bypass for the treatment of morbid obesity. It was in the list of noncovered procedures along with VSG (43775). I have BCBS North Dakota. I am in the appeal process with them. The kicker with them is that they are covering some sleeves in a pilot program, as long as you live in North Dakota and have a plan that covers WLS. Our plan covers WLS, but because I live in Oregon, not there they are saying NO, even though I have the proper coverage.

The problem is that the Medicare system is very difficult to understand. You have part A, and Part B, and supplemental insurance... :-0

None of my appointments with my surgeon or his PA (for supervised diet) are covered by my insurance until I have a preapproval. I have been using our flex spending for these appointments, and then when/if insurance goes through, then I will get reimbursed from the surgeon's office for the amount I paid that is over the percentage the inusrance would pay.

My psychiatrist billed my insurance for "an initial visit" so it was covered. There was nothing mentioned about bariatric surgery, because my ins. won't cover anything directly related to obesity until I get the preauthorization for surgery.

Absolutely precious (or totally precocious) lol

Completely off the topic but I LOVE Basset Hounds! They are some of the most entertaining critters on the planet:lol0:. And yes, they just LOVE bunnies...

Nice to see another North Westerner, welcome! Your story is very similar to mine, in that my husband didn't seem to think it could happen for a long time, then after the seminar, was very motivated to see that I got it done. Of course his excitement has waned a bit as I had to do a 3 month diet, and some other delays. But there is light at the end of the tunnel. All prep work is done except my last weigh in, which is coming up the 17th. Then we submit to insurance. I am sure there will be a fight there, but we will see. Good luck with your journey, and keep us posted!

I hope BCBS starts covering it soon. My ins. company (BCBS North Dakota) is covering it at select facilities in North Dakota, but I don't live anywhere near there. I am hoping that with the information that comes out of the conference, and ASMBS encouraging it, the VSG will be attainable to me when I am done with everything this summer.

This is a quote from a ASMBS report regarding Aetna and UHC beginning to cover the VSG. They are hopeful that other insurance carriers will follow suit soon.

"We are pleased that Aetna and United Healthcare now includes sleeve gastrectomy among its covered bariatric procedures," said John W. Baker, MD, FACS, President of ASMBS. "In the rapidly changing field of bariatric and metabolic surgery, it is important to provide coverage and access to a wide range of proven treatment methods. Sleeve gastrectomy has now reached that threshold where the data and our experience with the procedure supports its safe and effective use in people affected by the chronic disease of morbid obesity."

Here is a link to the whole report. http://asmbs.org/Newsite07/news/ASMBS-Sleeve_Gastrectomy_insurance_coverage_seo_FINAL.pdf . You may have to copy and paste it into your browser. Hopefully between this and the Bariatric Surgery conference coming up in June, we will see more people being successful with insurance coverage.

Good luck to you. Don't let anyone discourage you from doing what you think is best for you. I haven't told my parents, or in laws for that very reason. I don't want to hear it. I have plenty of support from my husband and even my co workers are onboard. Keep us posted on your progress, you will be great!

Congrats! Hope all went well! Keep us updated.

Welcome to VST! This is a great place for support and to get questions answered. Everyone here is exceptionally friendly!

When I had my oldest son in 1991 he was born at 6:40 in the morning and I was home by 4:30 for Thanksgiving dinner! They didn't even give me the option to stay overnight. I was on Idaho medicaid at the time so that is probably why. With the births of my 2nd and 3rd I had private insurance, and stayed 2 1/2 days.

I talked with my surgeons coordinator, (due to the possibility of having to self pay) and she told me that the band and VSG are both outpatient surgeries, with stays from 6 to 23 hours. I am 2 hours from the hospital, so we are probably going to get a motel room near there the first night.

Congrats! Glad to hear you had a positive experience. Good luck and hope to be joining you soon.

Thank you. I am going to look into it, either way. The mexico thing is not an option for me at all, I just don't have that kind of money and no options for borrowing it either. I am going to do some calling next week to find out what I would have to do to get this done. As soon as I know what the requirements are I will post it here.