I read some insurance will cover VSG as long as it's not laparoscopic...I thought it was always done laparoscopic so I'm confused. Thank you for your help

Not always, sometimes through the navel only,

Perhaps like a bypass when sometimes they do the old fashioned way where they cut you from the belly button to the chest line and open you up like you're a miniature box of cereal

(In honesty I would get a surgeons opinion,laparoscopic is the least intrusive way to go as far as I know, anyones pictures will show how minimal the scarring is, and look very impressive)

This sounds really bizarre. I'm not sure if this means they would only cover if it is an open procedure, but if so I don't know why they would favor a more invasive approach. I have never heard of this. In any case, just focus on what your insurance company requires. There are some plans with strange provisions in their plans, but don't let that throw you off.

I've never heard this and would seriously question the insurance company about this policy if it turns out to be true. Laparoscopic surgeries are generally much safer than open approaches and the risks for post-op complications would be significant. Insurance companies are in the business of managing risks so it wouldn't make sense for them to cover an open surgery but not a laparoscopic one.

Thank you all...I also was very confused as well.

Not sure of the context in which you're getting this info and I've never heard of insurance company telling a physician which technique they pay for. And the technique varies that I understand from my surgeon. If they can't get in laparoscopic due to extreme belly fat or other medical/health conditions they do open procedure which takes them longer and it's a longer hospital stay. And often they don't know until they get you in the OR most times

1 hour ago, neenee717 said:

Not sure of the context in which you're getting this info and I've never heard of insurance company telling a physician which technique they pay for. And the technique varies that I understand from my surgeon. If they can't get in laparoscopic due to extreme belly fat or other medical/health conditions they do open procedure which takes them longer and it's a longer hospital stay. And often they don't know until they get you in the OR most times

Ok...I took a screenshot of what someone sent to me saying some won't pay for it laparoscopic. Hopefully I can upload it here somehow..still new to this site

Ok...I took a screenshot of what someone sent to me saying some won't pay for it laparoscopic. Hopefully I can upload it here somehow..still new to this site [emoji4]

Looks like they don't cover open lap band or

VSG surgeries, whether they are laparoscopic or open procedures. They probably cover the bypass or other similar.

It depends on the persons policy.

My policy covers but it's a whole bunch of hoops to jump through and u have to go through their BariatricPal program. So it varies

That's so odd they say they cover gastric sleeve but not sleeve gastrectomy. I was under the impression those were different works for the same procedure. Color me perplexed!

Ok...I took a screenshot of what someone sent to me saying some won't pay for it laparoscopic. Hopefully I can upload it here somehow..still new to this site [emoji4]

Is this a current copy of insurance requirements? My insurance changed their policies on WLS quite a few times over the years.

2 hours ago, jess9395 said:

That's so odd they say they cover gastric sleeve but not sleeve gastrectomy. I was under the impression those were different works for the same procedure. Color me perplexed!

That's why I was so confused lol

This is mind blowing...it seems they would pay for the less invasive since that means shorter stay in hospital. Regardless stay focus on your goal and prepare yourself for whatever way they do it. Good luck!

Sent from my SM-G935V using BariatricPal mobile app

I second checking to see if this is a current policy. The copy you put up states vertical banded gastroplasty is covered, but per my insurance, that procedure is no longer a standard of care. This looks outdated.

ETA: I also see your screenshot is from a site called obesityreporter.com. I don't know what kind of a site this is, but you should be speaking directly with your insurance company (call the # on the back of your insurance card). One insurance policy will not be the same as another, even if it the same insurance carrier. Every group has their own plan. Calling your insurance will allow you to get a link to a current policy the insurance company uses to review, as well as any additional stipulations your specific employer group may have.

Edited July 3, 20179 yr by MSinger
spelling

Ok so I spoke to my insurance people and I think I'm more confused and frustrated. Lol.

1. They will cover me if medically necessary. - ok great.

2. She tossed out a bunch of numbers to me when I asked her how much I would owe on my end. I explained that this was all new to me as far as dealing with insurance and she really didn't elaborate more on what I was asking her to in reguards to my payment part if there was anything. She aid "well you haven't meant your $250 deductible yet and you won't pay more than $6k in co payments for the year" - umm ok...more confused.

3. I asked her about the info linked to the screenshot I posted and she simply replied "yes that isn't anything knew and it's like that sometimes" - I felt this was so vague.

4. She kept telling me ALL wls are outpatient. I said not from all my research they're not..I explained all the info I've got on here and from watching YouTube videos from others and they all stayed at least overnight. She kinda argued about that saying it's all outpatient and it's been like that.

So I'm frustrated thinking I would have better info today but I don't. Ugh. Thank you to all who commented...I have gotten more info and help on here than anywhere else.

2 hours ago, RaynaRayne said:

Ok so I spoke to my insurance people and I think I'm more confused and frustrated. Lol.

1. They will cover me if medically necessary. - ok great.

2. She tossed out a bunch of numbers to me when I asked her how much I would owe on my end. I explained that this was all new to me as far as dealing with insurance and she really didn't elaborate more on what I was asking her to in reguards to my payment part if there was anything. She aid "well you haven't meant your $250 deductible yet and you won't pay more than $6k in co payments for the year" - umm ok...more confused.

3. I asked her about the info linked to the screenshot I posted and she simply replied "yes that isn't anything knew and it's like that sometimes" - I felt this was so vague.

4. She kept telling me ALL wls are outpatient. I said not from all my research they're not..I explained all the info I've got on here and from watching YouTube videos from others and they all stayed at least overnight. She kinda argued about that saying it's all outpatient and it's been like that.

So I'm frustrated thinking I would have better info today but I don't. Ugh. Thank you to all who commented...I have gotten more info and help on here than anywhere else.

Regarding #2, if you are calling in to check benefits, the representative will typically tell you all the financials related: deductible, in and out of network benefits, out of pocket max. They like to dump the data on you. I'd recommend calling back and ask for an Explanation of Benefits letter (EOB) to be sent to you. At least then, you'll have it in writing.

As for #3, this is incredibly vague. Every insurance company has a medical policy that explains what criteria must be met for surgery to be approved. These are typically available online. You said you have BCBS, so maybe search on their website and see if you can pull up a copy of their bariatric surgery medical policy. You can also call your insurance and ask them how to find their medical policy. That information is available to everyone and you many be able to get to it yourself if you go to the BCBS website.

#4.. well, first off, I don't know how true this is. Gastric bypass and duodenal switch procedures do qualify as inpatient procedures per my insurance. My sleeve gastrectomy was approved as an outpatient procedure, but I had to be admitted inpatient for 2 days after my procedure and they covered it. They just did not approve an inpatient stay until they were sure I needed it.

I recommend you call your insurance company back. The rep's answer to #3 was not acceptable. If you are getting more vague nonsense ask to speak with a supervisor.

Ok so I spoke to my insurance people and I think I'm more confused and frustrated. Lol.

1. They will cover me if medically necessary. - ok great.
2. She tossed out a bunch of numbers to me when I asked her how much I would owe on my end. I explained that this was all new to me as far as dealing with insurance and she really didn't elaborate more on what I was asking her to in reguards to my payment part if there was anything. She aid "well you haven't meant your $250 deductible yet and you won't pay more than $6k in co payments for the year" - umm ok...more confused.
3. I asked her about the info linked to the screenshot I posted and she simply replied "yes that isn't anything knew and it's like that sometimes" - I felt this was so vague.
4. She kept telling me ALL wls are outpatient. I said not from all my research they're not..I explained all the info I've got on here and from watching YouTube videos from others and they all stayed at least overnight. She kinda argued about that saying it's all outpatient and it's been like that.

So I'm frustrated thinking I would have better info today but I don't. Ugh. Thank you to all who commented...I have gotten more info and help on here than anywhere else.

So it sound like you have a $250 deductible which means you have to pay the first $250 off medical bills when the year starts. Then the yearly maximum is $6000 so that means after you have paid $6000 towards your medical bills then the insurance will cover the rest of the year at 100%. So for example I have a $1300 deductible then after I've paid $1300 them my insurance will pay 90%and I pay 10% until I've paid $5000 that is my out of pocket maximum.