Medicare Coverage For Gastric Sleeve Surgery?

[monty 18]

Has anyone here tried lately to get medicare coverage of the sleeve? They authorized payment for the by-pass but now after much research I want the sleeve and they won't approve it. Just wondering if anyone else has had any experience like this.

Thanks!

[reallyrosy 161]

Me too. I will be self pay for the sleeve if Yale ever gets around to scheduling me....quoted about $25,000

[BettyBoop 28]

Me too. I will be self pay for the sleeve if Yale ever gets around to scheduling me....quoted about $25,000

OK, I am on Medicare. But I am on an Advantage Plan that anyone can get through Medicare. I am having the sleeve at the end of this month and Medicare/Kaiser is paying for it!

[monty 18]

OK, I am on Medicare. But I am on an Advantage Plan that anyone can get through Medicare. I am having the sleeve at the end of this month and Medicare/Kaiser is paying for it!

[monty 18]

Hi, would love to know how you are getting it approved. I had my surgery Mon. I was aproved by my United Health care manged Medicare<BR style="RIGHT: auto" id=yui_3_2_0_16_131780830759345>for the by-pass. However after reading several books and researching on the net, I decided to get the sleeve. My managed care plan refused to cover it on the basis that they only cover what Medicare covers, even though there is a code for it. Better get it in writing as you wil see a people got rejected at the last minute. I am on your side and if you get it in writing I would love to hear back from you. Good luck

[reallyrosy 161]

The part I don't understand: they have a code for it. Why? It sounds like a huge conspiracy!

Like we need this as we decide getting 86% of our stomach's removed. If I were younger, i'd probably wait.

[BettyBoop 28]

Hi, would love to know how you are getting it approved. I had my surgery Mon. I was aproved by my United Health care manged Medicare<BR style="RIGHT: auto" id=yui_3_2_0_16_131780830759345>for the by-pass. However after reading several books and researching on the net, I decided to get the sleeve. My managed care plan refused to cover it on the basis that they only cover what Medicare covers, even though there is a code for it. Better get it in writing as you wil see a people got rejected at the last minute. I am on your side and if you get it in writing I would love to hear back from you. Good luck

Hi Monty,

I will call membership service's today. But I can't imagine Kaiser offering it to some patients, but not others. I wanted the RouNY, but my surgeon thinks the sleeve would be best for me because I am considered high risk because of some of the drugs I have to take that lowers my immunity.

But I will get back to you as soon as I find out anything!

I don't understand why they have a code for it, if they're not going to cover it!!

[BettyBoop 28]

BTW, I just found this post by Mr. Mason.

He says he has Medicare and Kaiser. Looks like he got his surgery. But I will still be calling Membership Services. Cause now you all have me worried...

http://www.verticalsleevetalk.com/topic/6667-kaiser-permanente-is-southern-california/

[BettyBoop 28]

The part I don't understand: they have a code for it. Why? It sounds like a huge conspiracy!

Like we need this as we decide getting 86% of our stomach's removed. If I were younger, i'd probably wait.

If they have a code for it, then they should approve it, I would think!!

[reallyrosy 161]

Yes and that's what drove me batty last year and the surgeon's office staff got mad at me. So now I am with another hospital not exactly close by but at least in the same state and a cheaper quoted rate. Medicare kept saying the surgeon knows what he has to provide and the surgeon's office kept saying "no, they won't cover it." One year later, back at the farm, I don't even bother calling medicare. The new hosp said upfront medicare won't pay for vsg. They, at least, didn't try to 'sell' me rny or anything else that is covered. So I don't feel like i'm at war with the people I'm entrusting with my well being. I just hope I have enuf to cover any 'unforseen' events. Scary stuff. Huh?

[BettyBoop 28]

OK! **** NEWSFLASH******

I called Kaiser's Membership Service's. I was told that the sleeve is COVERED through Kaiser's Senior Advantage's Medicare Program!

However, to be sure, I also called my Option's case manager. She also told me the sleeve has been covered since April of last year!!

So those of you want the sleeve, and have Medicare and are being denied coverage, you need to talk to some manager's of your Insurance Plans!!

I hope this helps!!!

BettyBoop

[reallyrosy 161]

So I would have to add kaiser permanente? What if my docs aren't in this plan? I don't even know whom to call....yes it gives me something else to think about, bettyb. I'll call somebody in the state to try to figure what's up....but why would the hosp flat out say medicare won't cover....????

[monty 18]

Unfortunately we are being discriminated against!!! (age) You can find a letter my husband and I wrote to the surgeon general and also medicare sent registered mail on a past post. Surgeon Gen passed it on to someone probably the circular file. My husband found out that you have to go thru 7 appeals (6 denials). What a beurocracy!! I was sleeved Monday because I just couldn't wait any longer and will appeal that way. Leters etc. Thank God for e-mails. If you hear anything please let me know. The more people we have behind this the better chance to be heard. Power to the people!!!

OK! **** NEWSFLASH******

I called Kaiser's Membership Service's. I was told that the sleeve is COVERED through Kaiser's Senior Advantage's Medicare Program!

However, to be sure, I also called my Option's case manager. She also told me the sleeve has been covered since April of last year!!

So those of you want the sleeve, and have Medicare and are being denied coverage, you need to talk to some manager's of your Insurance Plans!!

I hope this helps!!!

BettyBoop

[BettyBoop 28]

So I would have to add kaiser permanente? What if my docs aren't in this plan? I don't even know whom to call....yes it gives me something else to think about, bettyb. I'll call somebody in the state to try to figure what's up....but why would the hosp flat out say medicare won't cover....????

Reallyrosy,

If Kaiser covers it through their Medicare plan, then your Medicare plan should cover it. You need to talk to management.

P.S. Some people get Medicade and Medicare confused. I have MEDICARE, which is run by the federal government.

Good luck!!

[reallyrosy 161]

I have a special with my state...state employees have mecdicare primary and anthem secodary. I just got off the phone with the state and then with anthem. It requires pre authorization and that requires the surgeon's office to call anthem....I have a feeling I'm going to get my head bitten off where it won't grow back again....ugh