Hey Folks,

I just found out this morning that Highmark (Pa.) BCBS has denied by request for VSG . Apparently their medical policy requires a BMI greater than 50 and VSG as a 1st stage in a two stage procedure. My BMI is 37 with 2 comorbidities, I plan to appeal with a letter and substantiated research articles. My surgeon's coordinator says the surgeon will do a peer to peer review next week. For those of you who have gone through this, are peer to peer reviews typically successful in getting the insurance decision reversed?

Thanks

Lisa

I'm still a newbie at all this so I can't speak from experience but wanted to ensure that you were aware that the FDI earlier this year (around Feb) lowered the criteria for the guidelines for lapband to a BMI of 30 with comorbidities. I know that's not the same procedure but I think an argument could be made. The standard for the industry even prior to this decision seems to be BMI of 40 or 35 with comorbidities. I hope all goes well for you.