Medicare Coverage For Gastric Sleeve Surgery?

[BettyBoop 28]

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!!!

Monty,

I have no idea of the timeline you wanted the VGS. But I don't think this means anyone is being discriminated against. At one time, the sleeve was considered experimental. It no longer is. And MEDICARE is paying for mine through Kaiser's Senior Advantage. I think it is because if this is still happening, it is one's insurance isn't up to speed on what is covered and what isn't.

If you think this is bad, wait till Obama Care kicks in. We're all in trouble then! JMO

[monty 18]

Monty,

I have no idea of the timeline you wanted the VGS. But I don't think this means anyone is being discriminated against. At one time, the sleeve was considered experimental. It no longer is. And MEDICARE is paying for mine through Kaiser's Senior Advantage. I think it is because if this is still happening, it is one's insurance isn't up to speed on what is covered and what isn't.

If you think this is bad, wait till Obama Care kicks in. We're all in trouble then! JMO

[monty 18]

I don't know what state you are in, but here in FL if, Christ came down himself to ask, the answer would still be NO. My husband talked to the chief claims manager and he said at this time even though we have aarp united health managed medicare, no one under medicare will have it covered because there is not enough long term data.

I had my surgery Monday and we have started the appeal. He also said that if you were UNDER 65 some insurance companies would be able to sell you a separate policy to cover it. Once you are on Medicare no one is able to cover you thru medicare. If you are still working you could probably get it covered under the company policy. Not trying to scare you, but I would get the info they told you put in writing so you won't be in for a major surprise. If you get something in writing from medicare stating it is covered I would really appreciate it if you could share it.

Thanks for responding,

Monty

[BettyBoop 28]

I don't know what state you are in, but here in FL if, Christ came down himself to ask, the answer would still be NO. My husband talked to the chief claims manager and he said at this time even though we have aarp united health managed medicare, no one under medicare will have it covered because there is not enough long term data.

I had my surgery Monday and we have started the appeal. He also said that if you were UNDER 65 some insurance companies would be able to sell you a separate policy to cover it. Once you are on Medicare no one is able to cover you thru medicare. If you are still working you could probably get it covered under the company policy. Not trying to scare you, but I would get the info they told you put in writing so you won't be in for a major surprise. If you get something in writing from medicare stating it is covered I would really appreciate it if you could share it.

Thanks for responding,

Monty

Monty,

Then that must be that United Health Care is not covering it for ANYONE. But some health insurance companies that contract with Medicare DO. I also do know that my insurance, Kaiser Permanente through their Medicare Advantage Plan IS covering it. As far as getting it in writing, well, I can't do that. Sorry.

I hope you took the time to read the URL I posted.

Here is the link I posted in another thread. I'm new here, so I'm getting kind of lost. But this helps explain what is going on with Medicare and why some plans/companies don't cover it and some do.

< http://www.obesityhe...atley/#35508730 >

I wish you the best of luck!!!!

[monty 18]

My point is United Health Care, who also handles our united health managed plan does cover it if you are under 65!!! Many other major insurance compnies have come on board and are covering it for those under 65. Thus, age discrimination. I wish you luck. Post back after you get it and maybe it would be worth switching over to Kaiser. to those who are trying to wait it out. I would sooo love to be wrong!

Monty,

Then that must be that United Health Care is not covering it for ANYONE. But some health insurance companies that contract with Medicare DO. I also do know that my insurance, Kaiser Permanente through their Medicare Advantage Plan IS covering it. As far as getting it in writing, well, I can't do that. Sorry.

I hope you took the time to read the URL I posted.

I wish you the best of luck!!!!

[reallyrosy 161]

Hey, guys....

I just heard from my providers office that 1. They "didn't know" I had secondary insurance (I have copies of 2 prior emails & some faxed info wth this data on it) and 2. Medicare will be approving it (she didn't say when) --she got word from afscm??? quoting from memory.

So now I may need to repeat psych and nut evals but hey, what's the rush? I'm only 66. I got at least 40 years ahead of me...nah, no hurry. GRUMP!

Monty, how do u like being sleeved? Worth the agony, worry etc???

[monty 18]

Hey, guys....

I just heard from my providers office that 1. They "didn't know" I had secondary insurance (I have copies of 2 prior emails & some faxed info wth this data on it) and 2. Medicare will be approving it (she didn't say when) --she got word from afscm??? quoting from memory.

So now I may need to repeat psych and nut evals but hey, what's the rush? I'm only 66. I got at least 40 years ahead of me...nah, no hurry. GRUMP!

Monty, how do u like being sleeved? Worth the agony, worry etc???

[monty 18]

Doing well. Not in pain just discomfort from trapped air being absorbed. Thanks for asking

[Ruthie59 0]

Just called Medicare. The Vertical Sleeve Gastrectomy (Code 43775) is not currently covered by Medicare. They did tell me I could go to cms.gov and find additional info. I have not done that yet. Most insurances and state funded insurance is currently covering this but not Medicare yet.

[monty 18]

I didn't think things had changed. We need to start a petition!

[BettyBoop 28]

Just called Medicare. The Vertical Sleeve Gastrectomy (Code 43775) is not currently covered by Medicare. They did tell me I could go to cms.gov and find additional info. I have not done that yet. Most insurances and state funded insurance is currently covering this but not Medicare yet.

It is if you're in a Senior Advantage Plan. I am on Medicare. But enrolled in a Senior Advantage Plan. I am having the sleeve done 10/25/11.

[reallyrosy 161]

I got a date for 11/7. Medicare won't cover but mysecondary will cover what medicare rejects. So at least I won't pay 100%.

As for petitions...ain't gonna help nobody now.

Your date is rapidly approaching, Ruthie, how are you doing with that?

Monty? How is your sleeve working for you?

[legnarevocrednu 47]

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!

My doctor said a couple of weeks ago that medicare was going to start approving the sleeve procedure REALLY soon. Good luck!!

[reallyrosy 161]

As did my doctor's office as well but it ain't approved til it is approved and medicare is notriously slow to move in any direction. (Except up in fees)

I'm cleared to go for the surgery, I'm told but I am hoping to have somethin in writing from an insurance co

[monty 18]

Just had my two and a half week checkup and Dr. said I am ahead of schedule and Monday to start stage 3. Gave me something for nausea and said I may have thrush due to antibiotics I was on pre-op as well as in the hospital. He gave me an rx for that too. So I am good to go for two more weeks. Thanks for asking.

I got a date for 11/7. Medicare won't cover but mysecondary will cover what medicare rejects. So at least I won't pay 100%.

As for petitions...ain't gonna help nobody now.

Your date is rapidly approaching, Ruthie, how are you doing with that?

Monty? How is your sleeve working for you?