babygirl_sandy

Just got off the phone with medicare and they have no idea what report i was talking about and when i told her i downloaded it from their web site she acted like she was confused. So I really am confused as to what this report states and to what the actual medicare knows and are willing to tell us over the phone.. My surgeons staff seemed like she was annoyed at the fact that i was calling this morning for more information, then proceeded to call me back to tell me that she has contacted medicare and that they said it was not covered.. So can someone tell me who's stating the truth??? very frustrated!!

Congrats!! Sent from my SPH-D710 using VST

I'm here in Pennsylvania waiting for this decision to be official, I read in another post that they had more than enough research and patient input to make a positive decision.. Fingers and heart crossed.. Sent from my SPH-D710 using VST

Great news.. I hope medicare and medicaid start paying.. Sent from my SPH-D710 using VST

I have lupus, fibromyalgia, sjogrens and alot more great autoimmune problems and neither my surgeon or my Dr have said that I have to stop my Plaquenel at any point before surgery.. Only the day of surgery.. I know how you feel cause it took my Dr two years to figure out my medication regimen that would work for me and help with the pain.. I hope you get through this cause I feel your pain!! Gd luck.. Sent from my SPH-D710 using VST

Thanks.. Fingers cross and heart on the edge that this works.. I hope it helps her on her journey for approval.. Sent from my SPH-D710 using VST

I had the same task for my insurance and i chose to write up my own letter and take it to my appt with my PCP. He was actually happy that he had a starter letter and he could always add or delete what he felt would be needed for an approval.. He was very clear that he could not be specific as to what surgery i should get but he could write that the surgery was medically necessary. Only the Surgeon can specify what surgery is right for you.. SO this is my sample letter I took in as my ice breaker and he really appreciated it.. Hope this helps!! June 29, 2012 RE: Name XXXXXX DOB: XX/XX/XXXX Medicare ID# XXXXXXXX Medicaid ID# XXXXXXXX To whom it may concern, This letter is in support of bariatric surgery for XXXXXXXXXXX. I have been Ms. XXXXXXXXX’s primary care physician for over XX years. The patient has been overweight since she was first seen in my office. I am referring her now for bariatric surgery as all non-surgical options have been unsuccessful and feel this is a medically necessary procedure to help her with her morbid obesity diagnose and co-morbidities. Ms. XXXXX has tried multiple times to change her diet and increase exercise but with no success. She has been seeing a nutritionist through her Urologist specialist to help her maintain her current weight, which is considered Morbidly obese. In addition to morbid obesity, Ms. XXXXX is suffering from the following co-morbid conditions: Hypertension, Stress incontinence, Low back and lower extremity pain, edema, shortness of breath on exertion. Ect.... Ms. XXXXXX has been obese for XX years and morbidly obese for XX years with all the weight ups and downs she has endured throughout her adult life. She is X-X” tall, weighs XXX pounds and has a BMI of XX.X she has tried multiple weight management programs including Weight watchers, Slim fast , La weight loss, Fasting, liquid diet, Green tea diet, Atkins, Over the counter diet pills. Some were even attempted more than once however she has not lost enough weight to resolve her morbid obesity. Additionally, she cannot sustain the weight loss that occurred on diet regimens and has gained the weight back or even more. She is limited due to her co-morbidities and her ability to exercise. Her family medical history is significant for both maternal and paternal for obesity, hypertension, heart disease, and diabetes. I believe Ms. XXXXXXX has tried many non-surgical methods of weight loss with limited success and has continued to struggle to re frame from gaining more weight. I am in favor and support her decision for a surgical treatment option. I feel bariatric surgery could eliminate and significantly improve many of her current health problems as well as her overall lifelong health. I strongly urge you grant XXXXXXXXXXXX’s request for bariatric surgery for treatment of obesity. I trust this information will aide you in understanding the true severity of Ms. XXXXXXX case and in facilitating the proper assessment. Please feel free to contact me if I can answer or clarify any questions you might have. Sincerely, Dr. XXXXXXXXXXX

Hello everyone so today I had my psych and Nutritional evaluation and was told it was going to take two Weeks to get their reports.. Has anyone gotten it sooner? Then they would submit to the insurance company.. Now my question to the nurse was " will Medicare and medicad cover my sleeve surgery and she said "no not yet but there are talks going on" ok so I took and called medicare since its my primary and the operator stated "if the procedures that are on the list are not medically your match then the provider "surgeon" has to call and explain for approval.. Has anyone run into this cause I really am not medically compatible with any other wls other than the sleeve.. ?? Sent from my SPH-D710 using VST

So I called and the rep from medicaid for pa stated any information or request for approval have to come from my surgical provider.. Sent from my SPH-D710 using VST

I will be calling tomorrow morning.. Thank you.. Same to you.. Sent from my SPH-D710 using VST

Congrats to the both of you and plenty of good thoughts and prayers coming your way... Sent from my SPH-D710 using VST

That's great.. I've been working the nerve to start but when I see myself on the video, i'm like no way!! Lol Sent from my SPH-D710 using VST

Congrats and you can do anything and get thru this with flying colors.. Sent from my SPH-D710 using VST

Congrats.. Glad to hear that everything went well.. Sent from my SPH-D710 using VST

Thank you, me too I've been praying ever since.. Sent from my SPH-D710 using VST

Just wanted to share that I just got off the phone with my hematologist and he has finally given me clearance for surgery, he was a bit hesitate since I do have anemia because of my lupus but feels its under control and since i'm getting the sleeve and not the bipass he is ok with saying "She is cleared for surgery".. I almost cried cause I really thought this was going to be the one thing to hold me back from surgery.. Now I only have my psych and nutritionist appt left on June 19th so hopefully I'll have a date Soon!! Sent from my SPH-D710 using VST

congrats on the July date hopefully we can be sleeve sisters.. Sent from my SPH-D710 using VST

Congratulations.. Can't wait to say those same words!! Good luck with your preop prep.. Sent from my SPH-D710 using VST

My surgen suggested 155_145 would be realistic weight goal.. Then if you go further than great.. Sent from my SPH-D710 using VST

Congrats.. Sent from my SPH-D710 using VST