Is Medicare really covering VSG? or not?

[annoymous 0]

Medicare is coving the sleeve if you have liver failure or a serious liver problem. Your doctor must call the provider line and get a direct acess to the contractor with your situation only the contractor can approve and process your claim, if you lose you can appeal to a administration law judge, go for it girl. I like it best also hate the lap band and the bypass, well it a trade off for different sickness. I understand also that medicare advantage might cover it now also that is medicare C, check before you change as there are over 200 plans.

[fightforjustice@yahoo.com 0]

I recently was told by Medicare that the best thing to do to get the gastric sleeve operation approved by Medicare is to write to my local congressional representative..so I did. If you want to read my letter to Rep.

Ted Deutch in Boca Raton, Florida you can find it by googling "Having Medicare approve the gastric sleeve

operation to rid millions of diabetes...also met a woman on line today who shares my determination to have

Medicare cover the sleeve surgery..so we've decided to create a National Petition where people can list their

names and make a comment or two. . We believe there is power in numbers. We plan on creating this National Petition tomorrow. Please add your name to it if you share our vision of hope regarding this procedure being covered FINALLY by Medicare. Will keep you posted once we figure out where this petition should appear.

[Cool Headed 0]

I met with my surgeon today for the first time -- really liked her! We both understood that medicare now recognizes the new code for VSG surgery, but she wasn't sure if they were actually covering the surgeries. I have private insurance, not medicare, but it could help my case if they are approving VSG surgeries. So, have any of you been approved for VSG in 2010 through Medicare?

Thanks for any insight!

[Cool Headed 0]

Sorry to tell you that on Dec. 15, 2010 I had the VSG and Medicare refused to pay one cent on the operation. I want to appeal their decision and if anyone appealed Medicare & won I need desperately to hear from you. My hospital bill was $10,100. and my surgeon fee was $9000.00. The surgeon I had to pay up front before surgery and the hospital allowed me to have the surgery and now want their money. I am doing remarkable. I have lost 55 pounds and my Type II Diabetes is in remission. I had no complications from surgery and I feel great. I am 61 years old and feel like I am forty again. I have so much energy now. I encourage anyone who is over weight and have health issues get the surgery. I am so happy I had the surgery. My health has improved greatly. No more Insulin, Byetta, Glipizide, Blood Pressure pill and my Lipitor is ready to go. My family doctor was against me having this surgery, however since seeing me doing so well she wants to have some of her patients to go to & get the surgery.

Cool Headed.

[Cool Headed 0]

Good Luck. I had the surgery in Dec. 15, 2010 and Medicare will not pay one cent toward my bill. I no longer have Type II Diabetes. Praise God. I no longer have depression because my Type II Diabetes is no longer attacking my body. May 2010 I was told by my eye doctor that diabetes was in my left eye and right then I had enough. I made an appointment next day and began my journey in July 2010 toward VSG surgery. I need two knee replacements and I was not about to give up Nsaids for pain. My doctor tried me on topical Nsaids and I had a severe reaction to the medication and had to stop immediately. No way I was having gastric bypass & suffer with pain all the time.

I hope some one out there can help me with appeal. I need Medicare to pay for this surgery. I was billed $10,100.00 for hospital expense and I had to pay $9000.00 up front to the surgeon. I am on a fixed income.

I am not giving up having Medicare pay this bill for VSG surgery. I am going to fight their decision all the way. I want every one to have VSG surgery that need surgery. I just research some more on why a person should have VSG & not gastric bypass and the information I read said VSG people live 5 times longer than Gastric Bypass people.

Cool Headed

[Sharra 0]

I was scheduled to do sleeve on May 27, then on Wednesday I was informed that I can't do it because Medicare isn't paying for it. My doctor told me Medicare was supposed to start covering on Jan. 1. That isn't happening. I have the code but it does no good if they don't cover it. I did call medicare and was told that they to band, By Pass and By Pass Revison. I asked if they would start doing the Sleeve any time soon. The lady said she didn't know and the computer was down. I'm very disappointed and am now trying to decide if I should do the By Pass:sad0::blushing:

No, don' go for the bypass! Too many problems such as mal absorption, dumping, bleeding. These are not problems with the sleeve. Push for the sleeve. Write, post, ask when "they" are going to realize that it is in the best interest of the economy to allow a safer, less expenisive surgery that also costs less in the long run.

Sharra

[Cool Headed 0]

No, don' go for the bypass! Too many problems such as mal absorption, dumping, bleeding. These are not problems with the sleeve. Push for the sleeve. Write, post, ask when "they" are going to realize that it is in the best interest of the economy to allow a safer, less expenisive surgery that also costs less in the long run.

Sharra

[Cool Headed 0]

Don't have the Gastric Bypass unless you have a lot of health issues for now. Gastric Bypass is out dated for the time we are living in. Gastric Bypass is not as safe as Sleeve surgery plus it causes ulcers, bleeding, dumping, no Nsaid for pain,& I just read an article that VSG patients outlive Gastric Bypass patients 5 times longer. People have been waiting since 2009 for Medicare to pay for VSG Surgery and when I had my surgery Dec. 15, 2010 Medicare still is not covering VSG Surgery.

[monty 18]

I recently was told by Medicare that the best thing to do to get the gastric sleeve operation approved by Medicare is to write to my local congressional representative..so I did. If you want to read my letter to Rep.

Ted Deutch in Boca Raton, Florida you can find it by googling "Having Medicare approve the gastric sleeve

operation to rid millions of diabetes...also met a woman on line today who shares my determination to have

Medicare cover the sleeve surgery..so we've decided to create a National Petition where people can list their

names and make a comment or two. . We believe there is power in numbers. We plan on creating this National Petition tomorrow. Please add your name to it if you share our vision of hope regarding this procedure being covered FINALLY by Medicare. Will keep you posted once we figure out where this petition should appear.

[monty 18]

I recently sent this letter to Kathleen Sebelius to get the Sleeve covered. Perhaps if all of us sent her a email (see below) than we will get some action on this. United health Care, Atena and others cover the sleeve. See below what for entire letter

Medicare Savings, Age descrimination to get insurance, Medicare code 43775 approval

Thursday, September 15, 2011 12:20 PMFrom: To: kathleen.sebelius@hhs.govDear Miss Sebelius, My wife is on AARP Medicare Complete by United Health Care and wants to do something for her health and improve her quality of life. She is morbidly obese and has tried numerous methods to reduce her weight but finally decided the only option is Bariatric Surgery. This surgery will stop the sleep apnea, eliminate her prediabetic condition, improve her heart function, lower her blood pressure, take her off expensive medications, etc. She was approved by AARP Medicare Complete to have Gastric bypass surgery . The total cost of this operation is $24,110. My wife has had 13 surgeries and several lower bowel surgeries for diverticulitis, hernia, and bowel obstruction. Because of this we decided not to have the Gastric bypass surgery but to go with the Gastric sleeve surgery which does not operate on the bowels like the Gastric bypass surgery and does not have the problems of Vitamin absorptions.It is a less complication surgery in general with nearly the same overall health benifits. This Gastric Sleeve surgery is only $17,685 or $6,425 less than Gastric by pass surgery and is the wave of the future . Medicare could save a considerable amount of money if this procedure was approved. It has been used for many years here in the states and around the world and the doctors tell us it is a proven procedure. My Medicare Advantage plan will not cover the Gastric Sleeve surgery because Medicare doesn't even though there is a medicare code 43775 for the procedure.United Health Careis the company that provides my Advantage program and if I could buy a plan directly from them the Gastric sleeve operation would be covered completely. Because she is on Medicare they will not sell me a policy that will cover this procedure. If she were under 65 she could buy a plan to cover this. This is descrimination agaisnt her because of her age. United Health Care says they can only sell us Medicare plans. This is plane wrong!! I am asking you to review this and have Medicare consider covering this procedure for my wife because of her prior bowel operations and problems and for me since I will have to pay $17,695 if it is not approved. I am certain approval of this surgery procedure would lower Medicare's total cost for all patients who have Bariatric surgery as well as get my wife off some very expensive drugs and will help her have a better quality of life.

There are many others who are waiting for this to be cover as the days are slipping from their life Thank you in advance for any help you can provide us

[BettyBoop 28]

I'm on a Medicare Advantage plan and I'm having the sleeve done at the end of this month and Medicare is paying for my surgery!!

I don't know if this applies to those just on regular Medicare....

[azsenior 12]

I have Aetna Medicare Advantage and have been approved for the sleeve on 10/18. My understanding is that Medicare denied it, but Aetna approved it.

I'm on a Medicare Advantage plan and I'm having the sleeve done at the end of this month and Medicare is paying for my surgery!!

I don't know if this applies to those just on regular Medicare....

[KellyL 173]

It depends on which State you live in I think? At least it is that way for Medicaid. I have seen some states have begun covering it under Medicaid, but a lot still haven't. I would try to find out from the Surgeons office you are interested in or contact your States Medicaid/Medicare office.