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Trying to get straight answers while trying to speed through the medicare maze is impossible. Friday i talked to one of my clients who is a physician and his wife supervises the billing department about my denial. They told me the same as others of this site that approval of the VBG is determined by how well the dr. words the request. They told me to contact Palmetto which I tried to do but was unable to secure any other customer service # other than the regular medicare #. I was lucky to talk to an telephone operator who gave me even more information to confuse me. Before she filled out the request to have someone call me I asked about after care if I decide to Self Pay. She said that under original medicare if I pay for something that it not covered under part B, that Part A would still pay for hospital costs. That's almost too good to be true so I would need to see that in writing or contact hospital billing. I'm still not convinced that I'm ineligible for this procedure because I've had 2 open abdominal surgerys and one lap. Plus i have diverticula. right now, i'm trying to stay calm so I don't over eat and gain back any that i've lost. Good luck to us all trying to jump through the medicare hoops.

I have medicare a & b, but i don't have a medicare advantage program. I have a ppo through my employment as a Los Angeles county employee that covers my share of the part b expenses and i can use it in any state with any hospital or dr. that accepts medicare. according to my ppo if medicare pays they will pay there share of the cost. i have been cleared medically so i've decided to not have the gastric bypass and explore all other avenues along with staying on the diet. i appreciate all of the comments from those who also have to jump through medicare hoops. i really think the sleeve is the best for me, i have had 2 open abdominal surgerys and my gallbladder was removed laproscopically so there has to be a lot of adhesions. good luck to us all marilyn:001_cool:

Good morning, I didn't get much sleep, thinking about my options and I have decided to cancel the surgery date. I;m sure the sleeve is the best option for me. Torrance Memorial requires attendance at many support meetings and every one states that it is a full time job trying to get the proper nutrients and Vitamins, after gastric bypass. I own a business and I have a husband that's not well and I also need both knee's replaced. I have to be able to take medicines for that condition without the worry. Mexico is out but I'm going explore all of the self pay options.If i pay for the surgery then the after care would have to be covered. Maybe this was meant to be and more thought should go into making this decision. Good luck to you, marilyn

I just had some bad news, and I though I'd share it with you. I just left the Dr's office for my pre op and they informed me that Medicare did not approve the sleeve. When I discussed my options, on Dec. 2nd I was assured that it would be covered. According to the staff they did cover last year, that was news to me. Effective Jan 1,the requests went on hold. Even though there is a code, the dr. must give a compelling reason why the other two options would not work and according to the dr. i don't have a acceptable reason why RNY will not work. I can't have the Lap Band because of a narrow esophagus. I still have my surgery date but I'm very bewildered. I can appeal the decision but how long that would take is anyone's guest. So we're back to square one. Now I know why so many go to Mexico for the sleeve. Good luck Marilyn

try medicare code 43775, that's the billing code i found on another forum, good luck marilyn

Hi, I started the program Aug. 27th expecting to go the Lap Band route even though I had friends that were failures. I was told on the initial visit with the physician all of the reasons why I wound not be a suitable candidate. I started the program with a 6 month surgery date. After my 2nd visit with the nurse practioner told me she would recommend me for an earlier date, even though I had not lost all of the weight they wanted me to loose. When I saw the Dr. on dec 2nd, i let him know of my desire for the sleeve instead of the RNY, because of my age and he concured. I don't know the billing code but i have seen it quoted on this forum as well as obesityhelp.com and thinner times forum. Last fall I also read in one of the Los Angeles newspapers health page that medicare no longer considered the surgery experimental. I am using the surgery center affiliated with Torrance Memorial Hospital in Torrance, Calif and I have medicare and part B with Anthem Blue Cross. In our state Kaiser is the largest HMO and they are also doing the sleeve for their medicare senior advantage patients. good luck, i'm on my way to my monthly support meeting. Marilyn

Hi, I'm 71 and scheduled for surgery on Feb, 17th. Medicare began to cover the sleeve on Jan, 1, 2010. Good luck, Marilyn

Thanks for the response. I just happened upon this link , I was beginning to think I was the only one over seventy to have this surgery. My primary care dr. wanted me to have gastric bypass 5 years ago, but I still wanted to try on my own. Even though I take Lipitor and my blood pressure is controlled by medicine, she felt i was a good candidate because I don't have any of the illness many have at my age. If I had the surgery when it was 1st discussed, I wouldn't have known about the sleeve. Even though it's the best option, for me, I don't know anyone that has had the procedure. Kaiser Foundation, which is the largest HMO in California has just started do the sleeve. I saw the cardiologist today, and I am scheduled for a treadmill exam. Other than the pre op that should finish all of my tests and hopefully the surgery will proceed as scheduled. Thanks for the offer for information, be prepared I have a million questions. Mentally I don't see myself as over the hill and with the surgery I will have a new lease on life. Marilyn' California

I just discovered your comments. I'm also 71 and scheduled for surgery on the 17th (I hope). They just let me know today that I would need to get a cardiac clearance. I thought all of the requirements had been met, but this office has a committee that evaluates all of the patients. it's very unnerving when you're trying to be calm. I also need both knees replaced and the dr's won't operate if I don't loose the weight. I'm glad I'm not the only one in this predicament.