want2livethin

I have finally talked to my insurance company. Humana Medicare Advantage covers everything else, but the sleeve. They have been studying it for two years and say that none of the top 5 Medicare Advantage Insurance providers cover it. Do any of you have an Advantage plan that has or is going to cover the Gastric Sleeve? If we could find Medicare Advantage companies that do cover the procedure and send that information to our individual companies perhaps we could make a difference! They also do not cover complications of the surgery. :smile::mad::sad0:

I have been lurking in LapBand and Sleeve Talk for awhile and today I went to a weight loss seminar. I had decided the sleeve procedure was best for me but found out that Medicare insurance will not pay for the sleeve and is now requiring a 6 month supervised diet for the other procedures. My options are self-pay here, self-pay Mex., 6 months diet and hope Medicare starts paying for sleeve, 6 months diet and have gastric bypass or lapband, or forget it. 1. If I have complications here or in Mex.Medicare would not pay and if they were bad enough (a stroke, etc) it could cost hundreds of thousands of dollars. 2. Self pay here is $20,000. Mexico would mean no one to do follow up. I could afford either one, but not hundreds of thousands of dollars if necessary. 3. Medicare could take years to decide to pay for sleeve so diet would not count. 4. If I lose more than 20lbs on 6 months diet I will have a BMI less than 40 and might not qualify for band or bypass. My health problems are not severe (joints, back pain, arthritis,high choesterol, bladder leakage), but I am a senior citizen and I am in a hurry. 40 years of off and on dieting is ENOUGH 5. I don't think band would work for me and gastric bypass scares me. What would you do?:cool0:

Thanks to all of you for your input. I am trying to just chill about this and let what happens happen. The way the doctor put it was "You'll have most of your stomach cut away and it is a very serious procedure." I am trying the South Beach diet and the pills. I don't know how long I can do it, but I am trying. I go back in two months and we will see. Most of his patients have diabetis or/and hypertension. He actually seemed shocked to see a 71 year old with no real problems and although he was very nice I have been thinking to him I must have seemed naive and cluelessl. People come from all over to see him, but I guess they are mostly high risk. I thought diet pills were a no no, but so far I am not having any problems. In two months I will reevaluate the situation. Who knows, maybe insurance will have changed their mind!LOL

I am glad it is working out for you. Straight Medicare covers it, but the individual private/government plans apparently do not. At least not yet. Medicare Advantage is a choice when you get to be 65. You can have the prescription drug plan and some extra benefits going to Advantage which is run by private company and Medicare pays them. Always sounded like a good option. Not now, obviously! I talked with the doctor yesterday (what a sweetie), but he says I am to healthy to have a sleeve (or for that matter a gastric bypass). He would consider a lap band, but doesn't think I need it. I am fortunate not to have high blood pressure or diabeties and my BMI is right at 40. He kept saying I was in excellent health, but he did suggest diet pills. I started them today and we shall see if they will work without side affects. People that have taken them say you don't feel hungry and that is what appealed to me about the sleeve. Good luck with your procedure. I probably will not be on here much, but I will check to see how it goes for you. Marilyn.you might be able to switch from Advantage to straight Medicare (if indeed it would pay) with a supplemental plan but probably not till open enrollment at the end of the year and who knows if it won't change again. Did I tell you that to go self pay one would not have any complication covered? At least not with Humana. Bye y'all.

I just got off the phone with a Humana Medicare Advantage person. They do not cover the sleeve. It doesn't matter about "Medicare" it is what each Medicare Advantage program decides to do. She said they had been studying it for two years and she said that none of the top 5 Medicare Advantage companies cover it. They (Humana) cover all the other procedures and do not require a certain period of diet supervision, but do require a record of diet tries (for want of a better word). If every senior interested in this procedure wrote their individual companies as well as Medicare and made enough of a fuss maybe we could get someone to do something. (She did not say this, I am just trying to be proactive). The policy does not cover any complication resulting from the surgery. So----

Oh Marilyn, I am very sorry. I can imagine how disappointed you must be. You were so close to your surgery date. I hope for you and for the rest of us that they will reverse the policy again. I wonder if a letter writing campaign to Medicare would do any good. Probably not. It is the government! Mexico scares me, but gastraic bypass and not having insurance coverage in case something goes wrong is even scarier. However, I know after much thought that the sleeve is the only procedure that suits me. Therefore, I am still going to keep my initial appointment with the surgeon today and proceed with the paper work in hopes of being able to have the gastric sleeve and I may consider self pay if I can find out if Medicare would cover any drastic results. Please keep me posted on your progress and if I find out anything I will post to you. There are going to be alot of unhappy people when they find out about Medicare. The best to you. Sandra

Hi Marilyn and CWALCK: Thank you both for the info on Medicare covering the sleeve. I have spent two days waiting to hear from my Medicare Advantage insurance about this, so I have been antsy about it. Ya'll responses are encouraging. Now if they would respond positively I will be a happy woman. Marilyn: I also am 71 and did live on the West Coast for years before moving South in my late teens. Santa Barbara in CA, Tacoma in Washington, and Klamath Falls in Oregon. Still have family in Pacific Grove. I hope both of you will keep me posted about your journey. CWALCK when is your surgery and do you have to do the 6 months diet with your pcp? Marilyn: Good luck on the 17th! Thanks again to both of you. Sandra

Hi Marilyn, The insurance person at the Obesity Surgery Center said they did not cover sleeve and told me about the 6 month diet requirerment. Do you have a Medicare Advantage plan? Do you know a number to call to find out if Medicare covers it or should I keep trying to get the answer from Humana? Did you have to do the 6 month supervised diet? Oh I hope they are wrong and you are right. That would be wonderful!!!!