Help with Medicare Plz!

[FreeToBeMe 2]

I have been reading here and there that Medicare is going to cover the sleeve in 2010. Has anyone else heard that? I called Medicare and the representatives only know about what has already been approved. My surgeon's office doesn't know anything. My surgery is scheduled for December and I am willing to put it off until early next year of course if Medicare will cover it.

Does anyone know how to find this information out?

Thanks so much for your time.

Pennie

[Bona Fide Diva 3]

Don't know if it will be covered right away. However, now that it has a CPT code, it probably won't be long now.

I'm in the same boat as you, I cant decide whether to chalk it up and go to Mexico or to try and wait it out.

[geobaby 0]

Gggrr me to! I am scheduled for December but I dont know if i should wait tell jan to see if my insurance cigna will pick up! I hear it know has a code but who knows how long it will be in tell insurance companies will pick it up, if they ever will.

[LAN2k 18]

I had straight medicare and I checked on their website and the sleeve was not covered. What I did was switch to a medicare advantage plan GHI Medicare PPO...I did this right before my surgeon submitted the paperwork with request for approval. GHI Medicare approved, they even phoned me to tell me that they did! I had my surgery on 9/15/09. If on the other hand Medicare is going to approve the sleeve procedure soon you may only need wait it out a little longer. You can call medicare and ask or go on their website and look it up. Someone over the phone can guide you through it. Best wishes to all of you.

[Queendiva 0]

Are you losing and are you satisfied with results so far? How much have you lost?

[LAN2k 18]

I have lost approx. 60 lbs so far. For me this surgery has caused a traumatic emotional downturn so I am not a good person to ask about satisfaction. I am on anti anxiety and anti-depression medications since the surgery. Sorry to say. But this is not the norm most of the people who've had this surgery are very very satisfied and happy. Best wishes to you in your journey.

[Queendiva 0]

I am sorry that you are having problems.:ohmy: Do you think it is a direct results of the procedure or is it compounded by other factors. I am already on anti-depressants and anti-anxiety meds. Since medicare isn't paying it seems I may have to do the Bypass:frown1:

[LAN2k 18]

I am sorry that you are having problems.:thumbup1: Do you think it is a direct results of the procedure or is it compounded by other factors. I am already on anti-depressants and anti-anxiety meds. Since medicare isn't paying it seems I may have to do the Bypass:frown1:

Firstly I want to let you know that I had Medicare and pre surgery I learned that Medicare would not cover the VSG. I took my chances and switched from Medicare to a Medicare Advantage Plan-GHI PPO III to be exact. Once I was switched over my surgeon submitted all the paper work, pre-surgical test reports etc. as well as his letter requesting approval for the VSG. Within 2 weeks I got a call that I was approved. In my situation I was able to make the switch to a medicaid advantage plan at any time. Depending upon your situation you may need to check with medicare to see whether or not you can change at whim or must wait for certain enrollment openings.

As for the depression and anxiety, yes there were/are other huge factors that occurred 2 weeks before my surgery. I moved from my home and my daughter took my place, she took back custody of her son who I had been raising since he was a baby. I moved a couple of miles away from them right before my surgery and felt emotionally stable. After the surgery however I was a mess and to this day I am suffering terribly with anxiety and depression. It's best to have this surgery if you have people physically in your life who love you unconditionally and will support you. If you read these boards you will find that I am in the minority. Most people are so happy they have the sleeve. I wish you the best in your journey.

[Polly K.P. 0]

I have been reading here and there that Medicare is going to cover the sleeve in 2010. Has anyone else heard that? I called Medicare and the representatives only know about what has already been approved. My surgeon's office doesn't know anything. My surgery is scheduled for December and I am willing to put it off until early next year of course if Medicare will cover it.

Does anyone know how to find this information out?

Thanks so much for your time.

Pennie

Dear Pennie,

I'm also very anxiously awaiting approval of VSG by Medicare. I was virtually 'promised' by my doctor that approval would happen in the first quarter of the new year (2010). The info I have that has 'filtered' down from his office to me, is that it is not likely until closer to the end of the year. I am very disappointed, discouraged and upset at this turn of events. I'm very concerned about gain weight during the wait for the surgery. I had to pay the $375 for the psychological evaluation out of my own pocket---will it need to be repeated? And will all the medical tests also need to be done again, closer to the surgery? I would sure like it if the doctors would be clear, honest, and frank in what they do and don't know. As far as my doctor, I think he's a great surgeon, person and wants honestly to help me. But I'm extremely frustrated and upset at what's happening.

Would sure like to hear from people in this same position.

Thanks,

Polly K.P.

[FreeToBeMe 2]

Dear Polly,

I hear your fustration with the Medicare system. I postponed my surgery from December to Feb because I had heard rumors on the internet that Medicare would come through early 2010. Well, that didn't happen and I realized that I couldn't wait indefinitely and I did not want the gastric bypass although a lot of Medicare folks end up getting one. I was very lucky to have my mother pay for the surgery. I decided that my risks for complications were low because I do not have any co-morbidities beyond sleep apnea.

I hope that Medicare does the right and smart thing in starting to cover the sleeve ASAP but I understand that you cannot wait forever in hopes that this will happen. Your psych test and nut eval will probably still be good later in the year if Medicares comes through. Blood work will be re-done I think.

My surgeon was up front that he prefers the VSG and thinks that it stinks that Medicare isn't covering it. Are you considering the gastric bypass? It comes down to how long you feel you can wait in hopes that Medicare will come around.

I am sorry that I couldn't be the bearer of better news. Hang in there and good luck.

Pennie

Edited February 15, 2010 by FreeToBeMe

[Polly K.P. 0]

Dear Penne,

This is Polly K.P. writing again. I saw my surgeon today, and he was totally unaware of any news that Medicare was going to put off deciding on whether or not to cover the VSG until much later this year. All he said was, "we don't know," and told me to hang in there, because I was #2 on the waiting list for the surgery.

Now I don't know WHAT to think, but will indeed, 'hang in there' because I have no choice but to do so.

He was going to "speak to" the person in his office who told me that the decision was being put off.

All I can say is, I will try and be patient, not one of my virtues! Thanks for your support.

p.s. I have to wait for Medicare approval, and cannot get the money from anywhere else due to my secondary insurance's rules.

[Polly K.P. 0]

This is Polly K.P.--Hi All, I am writing an update on my own thread, as I'm not sure how to use the Forum properly. I see my surgeon tomorrow for the next visit after he told me "we're hoping" when it comes to Medicare/VSG. He had originally 'promised' the first quarter of 2010 would be the time Medicare would probably cover my surgery. It's now at the end of the first quarter, and he's still "hoping". I'm getting more and more frustrated and honestly, getting angry at the surgeon for promising health, help and hope, and none of those are in the picture. It's like all the times I've done weight loss 'programs' and ended up being disappointed in one way or another. This is the biggest disappointment of all because it seemed as if it was going to be a success for sure. I honestly don't know how long I will be able to wait. I'm slowly gaining weight, or at the best maintaining. Feel very disgusted when I got the notice from Medicare about how much the "pre-surgery" blood work cost: $1.329.31!! And all for nothing. And the worst for me was having to cough up $375 for the psych eval....another wasted cost that was terribly hard for me to come up with--took all my nest egg, and now I'm broke at the end of each month. SSDI doesn't go far. Anyone have any news, or kind words? I really need both. Thanks to all of you. Best of luck. Polly K.P.

[Queendiva 0]

It seems like we are a group of frustrated wanna be sleevers. My situation is a lot like yours PollyKP. I am on disability which doesn't begin to give me latitude to do anything but depend on Medicare if I'm going to get the Sleeve. My doctor attempted to do the Bypass but I had too much scar tissue and he just sewed me back up and told me that the only thing I can do is the Sleeve. If the Medicare people will stop playing God and start looking at us as people who want to live healthier lives it would make more sense than what they are doing. Everywhere I look on the internet people are singing the praises of the Sleeve. Many who had or have the band are switching to the Sleeve because of all the complications they have encountered. I wish there was a way for us to join forces and demand they listen. Do think if we bombarded them with letters it would help? They say it's not enough proof that the Sleeve will work. One thing we all know for sure, and there is much proof, is that if we continue at our present weight, and if we haven't already developed a multiplicity of co-mobidities we will. We know that obesity is a killer. We know that there are statistics on top of statistics verifying this fact. The surgery will definitely help more than hurt and is guaranteed to save the government millions of dollars when you consider the astronomical cost of health care already. For once they need to listen to the voices of the people. I know, I know I sound bit disgruntled, OK a lot, but it is my life, our lives.

[Polly K.P. 0]

I saw my doctor two weeks ago, and don't quote me, ladies and gentlemen, we spoke through a lot of innuendos....but it's gonna be a while, folks, for VSG to even be considered by Medicare. The first "meeting" was supposed to take place in late January---hasn't even been scheduled yet. I tried to pin him down a little by asking how long it took LB to be approved. He said "about a year".....is that from the 'consideration' point? He evaded that. I then asked him if my upcoming Cranial Angiogram (used to be called "Brain Surgery!") was going to be a problem if it took place in May. "Oh no, not a problem," he said with assurance. I don't feel any better at all, as a matter of fact much worse, and didn't even make an appointment to go back.

Queendiva asked me if there was anywhere all of us could send a barrage of letters to....he said if he knew a name or section of Medicare, all the doctors would be doing a lot of barraging, too. Said there's no way to find out WHO to write to about our concerns and situations, and that he'd be the first to share that with me.

I'm not even half-way sure I will be able to get back into the positive mind-set I had about the surgery, and everything that follows it as I did before. I think (like all the times I tried other 'weight-loss programs') I feel like I've tried, and failed, once again. This time in a Big Way. I was offered Hope and Help, and they're down the tubes. I'm even considering withdrawing from the whole consideration process and dropping the whole thing.

[Queendiva 0]

Don't give up PollyKP..Although it may not help I am going to file a grievance as soon as I can get a letter from my doctor explaining why he couldn't do the LG or the GB. It may not help but I demand to be heard. I may even send a copy to the media. On Medicare's website there is a link for appeals and grievances. This is where I will start. I suggest that others do the same. There seems to be too many people who need the sleeve for us not to be heard. Like I said it is the difference being between being healthy or sick and getting sicker. It could be the difference between life and death for some of us. Some of us may not be able to wait another two or three years because that might be too late. For anyone who is interested you can go to this website (http://www.medicare.gov/basics/appeals.asp) and read about appeals and grievances or go to Medicare.gov, highlight "Medicare Appeals" and click on the link to "Appeals and Grievances." If we are going to go down, let's go down fighting. For me it's like I'm sick and can take only one kind of medicine and they are refusing to give me that. It's like they are saying,'It's not our fault that you can only take one kind of medicine so go ahead and die.' It's like they are saying 'we have the antidote to your poison but we haven't opened the bottle yet and we really aren't ready to open it just now so you will have to wait until we decide to open it, and if you die in the meantime, oh well.'

Edited April 3, 2010 by Queendiva