Medicare

[free2beme11 0]

Has anyone found out anything as to the Medicare approval date for the sleeve gastrectomy? I am new to this forum but not to obesity. I want this surgery so bad as so many people do!

[ProudGrammy 8,322]

i have medicare as my primary coverage, but empire blue cross as my secondary. MEDICARE does NOT cover the sleeve yet because its relatively new (few years or something. ) Medicare DOES cover the lapband and gastric bypass. (but i want the sleeve)

My surgery for the sleeve is 12/7 - medicare will send the "official" denial for the sleeve after hospital sends bill, empire needs to see the "official" denial first, and then empire looks at my qualifications in having the sleeve. I have all the qual.. (BMI, diabetes, high chlolesteral, and high blood pressure, and sleep apnea (aren't I lucky???!!!)

The insurance companies know that Medicare doesn't cover the sleeve, but they need the official denial after the surgery. Then the other insurance company can proceed. I know this sounds weird, its the beurocracy (msp) but thats how it was explained to me. Empire does cover the sleeve - so they told me after all the paperwork is sent in I will be 99% positive I will be approved. They can't officially guarantee it for obvious reasons. But they did tell me unofficially of course that everything looks fine.

so the bottom line is MEDICARE doesn't cover the sleeve, no if ands or butts, but your secondary might cover it, like my empire blue cross.

hope i've helped - without confusing you too much - write back w/any more questions )

[free2beme11 0]

Actually, not confusing at all. I do have a secondary insurance with federal gov't (GEHA). I have the same diagnoses as yours (but a few more)!. I will check on the secondary tomorrow. Thank you so much for the info and response. Stay well.

i have medicare as my primary coverage, but empire blue cross as my secondary. MEDICARE does NOT cover the sleeve yet because its relatively new (few years or something. ) Medicare DOES cover the lapband and gastric bypass. (but i want the sleeve)

My surgery for the sleeve is 12/7 - medicare will send the "official" denial for the sleeve after hospital sends bill, empire needs to see the "official" denial first, and then empire looks at my qualifications in having the sleeve. I have all the qual.. (BMI, diabetes, high chlolesteral, and high blood pressure, and sleep apnea (aren't I lucky???!!!)

The insurance companies know that Medicare doesn't cover the sleeve, but they need the official denial after the surgery. Then the other insurance company can proceed. I know this sounds weird, its the beurocracy (msp) but thats how it was explained to me. Empire does cover the sleeve - so they told me after all the paperwork is sent in I will be 99% positive I will be approved. They can't officially guarantee it for obvious reasons. But they did tell me unofficially of course that everything looks fine.

so the bottom line is MEDICARE doesn't cover the sleeve, no if ands or butts, but your secondary might cover it, like my empire blue cross.

hope i've helped - without confusing you too much - write back w/any more questions )

[marcia 0]

I heard from Medicare and they are reviewing approval of the Sleeve Gastrectomy. The policy is open and they are accepting public comments. The link is:

www.cms.medicare-covergae-database/details/nca-details.aspx?NCAld+258&ver=2&NcaName+Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity+(2nd_+Recon)&bc=ACAAAAAAAAAA

Please view the site and let's get some support going!

Marcia

name='free2beme11' timestamp='1318524370' post='218275']

Has anyone found out anything as to the Medicare approval date for the sleeve gastrectomy? I am new to this forum but not to obesity. I want this surgery so bad as so many people do!

[marcia 0]

I have gotten Medicare to reconsider accepting the Sleeve Gastrectomy. you need to view the psoting. They are soliciting public comments.

http://www.cms.gov/medicare-coverage-database/details/nca-details.aspx?NCAld+=258&ver=2&NcaName=Bariatric+Surgery+for+the+treatment+of+Morbid+Obesity+(2nd+Recon)&bc=ACAAAAAAAAAA

Please visit this site and post any information in favor. Thanks.

Marcia

name='likasulema' timestamp='1318798760' post='219248']

i have medicare as my primary coverage, but empire blue cross as my secondary. MEDICARE does NOT cover the sleeve yet because its relatively new (few years or something. ) Medicare DOES cover the lapband and gastric bypass. (but i want the sleeve)

My surgery for the sleeve is 12/7 - medicare will send the "official" denial for the sleeve after hospital sends bill, empire needs to see the "official" denial first, and then empire looks at my qualifications in having the sleeve. I have all the qual.. (BMI, diabetes, high chlolesteral, and high blood pressure, and sleep apnea (aren't I lucky???!!!)

The insurance companies know that Medicare doesn't cover the sleeve, but they need the official denial after the surgery. Then the other insurance company can proceed. I know this sounds weird, its the beurocracy (msp) but thats how it was explained to me. Empire does cover the sleeve - so they told me after all the paperwork is sent in I will be 99% positive I will be approved. They can't officially guarantee it for obvious reasons. But they did tell me unofficially of course that everything looks fine.

so the bottom line is MEDICARE doesn't cover the sleeve, no if ands or butts, but your secondary might cover it, like my empire blue cross.

hope i've helped - without confusing you too much - write back w/any more questions )

[free2beme11 0]

Marcia,

Could you please send me the link again. It would not open for me. Your message made my heart flutter as this is better news than I had imagined. Look forward to your response.

Patty

I heard from Medicare and they are reviewing approval of the Sleeve Gastrectomy. The policy is open and they are accepting public comments. The link is:

www.cms.medicare-covergae-database/details/nca-details.aspx?NCAld+258&ver=2&NcaName+Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity+(2nd_+Recon)&bc=ACAAAAAAAAAA

Please view the site and let's get some support going!

Marcia

Has anyone found out anything as to the Medicare approval date for the sleeve gastrectomy? I am new to this forum but not to obesity. I want this surgery so bad as so many people do!

[marcia 0]

Please contact me at my email address as it will be easier and clearer to transmit.. mkraftlaw@hotmail.com

Thanks..

Marcia,

Could you please send me the link again. It would not open for me. Your message made my heart flutter as this is better news than I had imagined. Look forward to your response.

Patty

I heard from Medicare and they are reviewing approval of the Sleeve Gastrectomy. The policy is open and they are accepting public comments. The link is:

www.cms.medicare-covergae-database/details/nca-details.aspx?NCAld+258&ver=2&NcaName+Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity+(2nd_+Recon)&bc=ACAAAAAAAAAA

Please view the site and let's get some support going!

Marcia

Has anyone found out anything as to the Medicare approval date for the sleeve gastrectomy? I am new to this forum but not to obesity. I want this surgery so bad as so many people do!