Medicaid Question On Vsg Coverage

[former_vbg 198]

I had private insurance (Aetna) and didn't have any problems getting approved and they paid the bills- thank god!

I have a friend who is very excited at the success I have had with the sleeve, she is younger and on Medicaid currently in Missouri. I told her I wasn't sure if Medicaid had this as a list of approved procedures.

Anyone with experience or know anyone who has gotten Medicaid to pay for the Sleeve?

[illgeturhairdid 176]

Here in NY my cousin is having to go with bipass surgery because Medicaid will not cover VSG, They will only cover LapBand or RNY. I'm not sure if each state is the same or not though.

[Aboutmethistime 1]

I live in Maryland and i am in the process of getting the VSG i have been to all of my doctor/specialty appointments except for the gastroenterology but i spoke with my insurance under medicaid for md and so has my surgeons office to make sure the vsg is covered and they said as long as it is medically necessary with the requested documents it will be apprived so we will see... Im not sure what kind of insurance your friend has under medicaid but has she called and spoke with anyone yet?

[former_vbg 198]

No, it was something that just came up in conversation when I saw her at Thanksgiving. She didn't know I had had surgery, and told her. She thought it was really neat, and has an interest herself. She currently has a BMI of 41 and has several other health issues. In fact, she is considering going on disability. I don't know all the details on that- but I guess the best thing is for her to call her state medicaid program since it appears maybe the state gets to dictate the different types of allowable coverage. The only thing I would be concerned about in seeing other people post about this is that it looks like calling people at Medicaid often becomes pretty futile as they aren't very forthcoming or helpful.

Does anyone know the CPT code Medicaid uses for the VSG? Maybe its different for different states- not sure how that works. It seems to be the same between private insurance companies. This is just all new territory for me.

I live in Maryland and i am in the process of getting the VSG i have been to all of my doctor/specialty appointments except for the gastroenterology but i spoke with my insurance under medicaid for md and so has my surgeons office to make sure the vsg is covered and they said as long as it is medically necessary with the requested documents it will be apprived so we will see... Im not sure what kind of insurance your friend has under medicaid but has she called and spoke with anyone yet?

[Aboutmethistime 1]

I am not too sure how each state works but I have Amerigroup through maryland medicaid so i called them and asked im not sure what the code was but they did say they covered it if it was medically necessary and u had to have a bmi of 40 or over or 35 i think with co-morbities. I also went to my pcp and spoke with her about my plan and she was excited as much as i was and referred me to a great surgeon i went to the seminar then went to the 1st consultation but before i even went to the consultation the surgeons staff called my insurance company first to make sure it was covered! I hope all works out for ur friend!!

[msboo79 10]

I was all set to have the RNY and about a month ago Medicaid decided to start paying for the sleeve and my surgeon discussed having VSG instead and from what I hear from a few people Medicaid is pretty good about paying. I'm in Alabama so I'm not sure about any other states.

[dragongrl75 2]

I know the VSG is covered by Medicaid in Colorado but I do believe it is a state by state thing...the code for it however is the same everywhere. Medical codes are a nationally standardized thing. For the VSG I believe it is 43843