Medicare Coverage For Gastric Sleeve Surgery?

[reallyrosy 161]

What causes the nausea? Is this heartburn? Are u on a med for that, too? And, if I may ask, what size bougie did your doctor use? Congrats on being "ahead of the game".

[monty 18]

What causes the nausea? Is this heartburn? Are u on a med for that, too? And, if I may ask, what size bougie did your doctor use? Congrats on being "ahead of the game".

The nausea can come from dehydration (the only way I could drink more would ne to stay up all night), ketosis (burning the fat) and/or this thrush. The bougie he used was 36. Glad you got your surgery date. What state are you in?

[reallyrosy 161]

Hi Monty. I'm in CT. I read recently that cms is going to decide whethr to approve vsg b y oct 30. Might be a nice halloween trick or treat!

Sigh.

[monty 18]

Hi Monty. I'm in CT. I read recently that cms is going to decide whethr to approve vsg b y oct 30. Might be a nice halloween trick or treat!

Sigh.

Well we're at opposite ends of the country! I'm in Fl. Curious as to what self-pay is on the sleeve up there. Would be great if it wasn't a trick!

[reallyrosy 161]

Initially I was quoted 24,000 but just before they gave up trying to convince me to do rny or an approved surgery. They told me it had gone up another 5,000 to 29,000. I was going to go for it anyway. Then I called bcbs and relayed to the hosp what they'd told me: if the doc pre certifies it as medically necessary then bcbs will pay what medicare doesn't. So this hospital is kindly running with that. The first hosp I tried a year ago, that surgeons office refused to follow thru on the information about bcbs paying wht medicare turns down. It has made me paranoid. I am worried, I'll wake up with a sleeve and a hole in my pocket. I can be prepared to py or I can be prepared to be covered but I don't like surprises and I have an instinctive distrust of all insurance coverages. They lie. They tell providers one thing and consumers something else.

For what reason would medicare have a code for a procedure if they don't cover it?

Bah obama, bah the u.s. health care system...if it is soooo wonderful as obama preaches, why are he and michelle and the kiddies exempt from it? Why isn't congress part of it? Hah????? Oh well. Going to get busy here. We're not quite opposite ends of the country, monty, but its a lovely fall day here. Whould u like me to send you some red and gold leaves???? <grin>

[monty 18]

Initially I was quoted 24,000 but just before they gave up trying to convince me to do rny or an approved surgery. They told me it had gone up another 5,000 to 29,000. I was going to go for it anyway. Then I called bcbs and relayed to the hosp what they'd told me: if the doc pre certifies it as medically necessary then bcbs will pay what medicare doesn't. So this hospital is kindly running with that. The first hosp I tried a year ago, that surgeons office refused to follow thru on the information about bcbs paying wht medicare turns down. It has made me paranoid. I am worried, I'll wake up with a sleeve and a hole in my pocket. I can be prepared to py or I can be prepared to be covered but I don't like surprises and I have an instinctive distrust of all insurance coverages. They lie. They tell providers one thing and consumers something else.

For what reason would medicare have a code for a procedure if they don't cover it?

Bah obama, bah the u.s. health care system...if it is soooo wonderful as obama preaches, why are he and michelle and the kiddies exempt from it? Why isn't congress part of it? Hah????? Oh well. Going to get busy here. We're not quite opposite ends of the country, monty, but its a lovely fall day here. Whould u like me to send you some red and gold leaves???? <grin>

[monty 18]

I would love to have some of those leaves. I lived in Ohio 40 years and Fall was my favorite time of year! The sunshine here is nice too! I think medicare coverage is determined by each state. FL is a no-go for the sleeve. However, the self-pay here is $18,000 for the sleeve, so you could have a nice vacation for the extra money!!! Let me know how you make out. I'll be thinking of you.

[reallyrosy 161]

Thanks, monty. Medicare is a federal program. The states got nothing to do with it. The supplemental medicare programs are state controlled. That's what I understand. But the fed gov't sets what medicare covers on a national level so if I can get it here thru medicare, you can get it there thru medicare.

Promise

[monty 18]

I would love to have some of those leaves. I will be 68 on Monday and I lived in Ohio most of that time and Fall was my favorite time of year! The sunshine here is nice too! I think medicare coverage is determined by each state. FL is a no-go for the sleeve. However, the self-pay here is $18,000 for the sleeve, so you could have a nice vacation for the extra money!!! Let me know how you make out. I'll be thinking of you. Please let me know if medicare changes to have it covered as I am at appeal level 2.

[BettyBoop 28]

I would love to have some of those leaves. I will be 68 on Monday and I lived in Ohio most of that time and Fall was my favorite time of year! The sunshine here is nice too! I think medicare coverage is determined by each state. FL is a no-go for the sleeve. However, the self-pay here is $18,000 for the sleeve, so you could have a nice vacation for the extra money!!! Let me know how you make out. I'll be thinking of you. Please let me know if medicare changes to have it covered as I am at appeal level 2.

Medicare is a federal benefit. All states are the same.

But many people get MEDICARE AND MEDICADE confused. Medicare is federal. Medicade is run by your state.

And again, If you're enrolled in a Senior Advantage Plan through MEDICARE, the sleeve will be covered.

[Ruthie59 0]

I think it is just government dragging their feet. The Sleeve has been found to be he most used operation right now. You don't need all the supplements like with the Bypass or the other one. So much safer not having to splice twice and increasing the risk for leakage. One good way to get so many off Medicare I guess, LOL. I was told that it was possible to get the Medicare Advantage Part C with some insurances and that it would cover it. Unfortunately, I have a supplement through the company my husband retired through and it will pay what Medicare doesn't and if I drop the supplement right now, I can never get it back. I am determined that the Sleeve is what I want. Both the seminars we went to said all indications are that Medicare will change hopefully in the first part of next year. I so wish I could just do this and get it over. I was told my knee will need to be replaced and that losing the weight would help my back problem too. I guess it is a waiting game cause the bypass scares me.

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

[Ruthie59 0]

Yes. I called them twice actually hoping to get a difference answer. Unfortunately, I got the same answer. It is not covered yet. It has a code number but as of yet, they will not cover it. I was told to keep a watch on cms.gov for and changes in the future.

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]

I must've misread u because I thought u were telling me and Monty to get the advantage plan. So your supplement will pay what medicare doesn't cover????

[Ruthie59 0]

I'm sorry I didn't make myself plain. I was told there were Medicare Advantage plans Part C that would cover the surgery, like Blue Cross or some of the competing plans. If you changed to one of these it might actually cover the surgery and it is open enrollment. They only cover 80 percent though and that would leave you owing the 20 percent copay as well as the Bariatric charges it doesn't pay ranging from 500-3000 dollars. Right now, I have Medicare and a supplement through my husband's retirement plan which would cover the 20 percent medicare doesn't. If I drop my supplement and change my supplement to a Medicare Advantage plan right now, it would make me cover the 20 percent and I could never go back to his supplement again. So, the only thing I can do is wait for Medicare to change so I won't have to pay the 20 percent. and I won't lose his supplement.

I must've misread u because I thought u were telling me and Monty to get the advantage plan. So your supplement will pay what medicare doesn't cover????

[reallyrosy 161]

My plan is the same and that is wht I am going to do...pay whatever bcbs doesn't cover. Its less than 29,000. I was going to pay that, myself. I absolutely cannot afford to wait any longer. As I told Monty, I'm a stroke wating to happen. My lungs and my heeart cannot tolerate the obese conditions much longer. I've lost 6# and (thanks to the incompetence of the first surgeon's office from 2010) a full year of my life. I'm praying for no complications and to emulate some of the success stories we read about in these forums. I'm 66. I don'tfeel that I have the luxury of time to mess around. Yes, I'll ask the surgeon pertinent questions @ the sise of the bougie he uses, but I think I would consent to a pickax and scissors and just get this over with, n o w!

Good luck with your decision as well.