Tuesday, November 2, 2010

Insurance Approval?

Hmm, I was looking at my insurance company's requirements for obesity surgery this afternoon. I know that they will cover the standard "gastric bypass surgery" and that they also cover the vertical banded gastroplasty (VBG), the type of surgery I want to have. However, it looks like, from the criteria, that I may have a hard time getting approval for the VBG. In addition to their standard criteria (e.g. BMI, co-morbidity or other conditions that affect your health such as high blood pressure or diabetes), for VBG you must have:

- complications from extensive adhesions
- liver disease
- Chrohn's disease or ulcerative colitis
- some poorly controlled disease (such as renal/kidney failure)
- Readiation enteritis (??)

Now, I see online that my insurance does actually approve VBG for people, and my surgeon does this type of surgery for people with aetna insurance. He hasn't raised a red flag about it, but I definitely need to follow up. I am less interested in the more invasive gastric bypass surgery, although I am not prepared to rule it out at this time.

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