Rejoice! Medicare & Medicade Coverage For Vsg Is Currently Under Medical Review!

[Greg_P 9]

I dont know if this has been discussed here yet, but I wanted to inform you all a Medicare medical review is nearly complete pertaining to official coverage of the VSG. If all goes well, we should have a peliminary decision at the end of this month (3/30/2012)! A final binding decision will be made no later than 6/28/2012.

Offical documentation can be found here....

https://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=258&fromdb=true

I spoke with my Bariatric Surgeons P.A. today and discussed the Medicare coverage review of the VSG. He told me based on his attendance at the annual Bariatric Surgeons convention he was told coverage for the VSG is very likley to be approved for Medicare. He did not want to cite names, but did say his information came from very reliable sources close to the review process. He went so far as to say (without prompting) "He would be shocked if the review panel rejected covering it this year".

Im starting my 6 month required supervised diet (ie Nutritionist) consultations now to be ready for submittal come October when Medicare updates it's coverage. Those of you on Medicare and Medicade who have been holding out for VSG surgery coverage I strongly suggest contacting your Hospitial's Bariatric cordinator and starting the nessicary legwork now. Starting now, I will have everything needed for insurance approval ready to go the moment coverage goes live.

~Greg

[300PoundsDown 101]

This is wonderful news. I am so glad to hear this. SOOOO glad. Thank you for sharing!

[ProudGrammy 8,322]

Fellow Sleevers

Greg, i'm truly happy for you and others, but its kind of funny about medicare now probably officially will be accepting the sleeve. i am on disability medicare, (I'm 58 yr. young) and when i had my sleeve 12/15/11 - medicare didn't accept the sleeve procedure. luckily i had a second ins from my office, BCBS, which after a long procedure w/medicares denial, BCBS covered the sleeve for me - but it was an extremely long process. I am so happy for all the other medicare people that will probably now be accepted for the sleeve without going through the hoops i had to go through a year ago. I just wish it had happened earlier - hope that doesn't make me an awful person - kathy

[Greg_P 9]

The memo with CMS's recommendations for coverage of the VSG has been issued!

https://www.cms.gov/...true&NCAId=258

Unfortunatley, and to my great dissapointment CMS has purposed NOT covering the VSG at this time. However, they say they will cover it (ie pay) under a clinical study provided all the required guidelines are met.

Just fired off a email to my hostipitals Bariatric director to see if they meet all the requirements and are willing to participate in the clinical study for qualified patients. Im hoping they will answer under the pretence that the Memo carries over as is to the final decision and not blow me off with something like "ask us again when the final decison is given"

[Anjelika 14]

Bah. So, this means Tricare won't cover it either. Where can I sign up for the study? Lol this seriously sucks.

[Greg_P 9]

Bah. So, this means Tricare won't cover it either. Where can I sign up for the study? Lol this seriously sucks.

This "purposal" of CMS is not a binding decision until 6/27/2012. They could technically change their mind between now and then though I think that to be unlikley as the main reason in denying VSG coverage is lack of "long term" data. They admit the surgery is promsing which is why they purpose the clinical study but none of this is "official" until the end of June.

I contacted my hostipital's Bariatric director with all this info and "hope" they are willing to answer me about participating in a clinical study by "assuming" the Memo reflects CMS's final decision. A answer would at least offer some resolve, but my hostipital may very well refuse to "extrapolate" on a Memo and tell me to ask them again when a "offical" binding decision has been made.

So for right now the most you can do is see if your hostpital meets the requirements for the clinical study (Memo details this) and if they do, ask if they are willing to participate and submit qualified canidates.

[Anjelika 14]

Yeah, I understand where they're coming from. I'm just anxious to have it done. I know that the program I'm in have a study going on right now that is, I want to say, "free," but you must have diabetes, which I don't. I'm going to call them again today and see what other options I have besides self pay. Thanks for posting the info tho, Greg!

[gingersnap 11]

I must say this is not what I was expecting to hear. Thanks so much for posting this information and please keep us updated on what you find out. I'll keep hoping and praying for coverage. It's a shame that there is a better surgery than gastric bypass but our insurance companies are not willing to support it at this time.

[cam 15]

Bah. So' date=' this means Tricare won't cover it either. Where can I sign up for the study? Lol this seriously sucks.[/quote']

I got sleeved at a military hospital last July, as did 2 of my friends. We were at BAMC at Ft Sam Houston.

[Anjelika 14]

Cam~ yes, my MTF does VSGs, but that's separate from Tricare. Unfortunately, Tricare doesn't cover VSG at this time. I really want to have it done through another bariatric program here. I went thought the program twice, once for traditional weightloss and the second for gastric bypass. The second time around, I found out I was pregnant, so i did not go through with the surgery. So, my two options this time around is that I could have it at the MTF (which I'm really freaked out about) or at the WLS program I already know, but then will have to self pay.

[empirejd 1]

I posted today (April 2, 2012) that on or about March 29, 2012 Medicare is looking for additional research and public comment before they will approval the VSG. See my post today for the link to Medicare and their study.

[gingersnap 11]

So at this point I have started to research MTF's. I live in the Charleston, SC area and looking for an MTF that does the Sleeve. I've heard of one person going to Columbia, SC and having theirs done at Fort Jackson/Moncrief Army Community Hospital and possibly someone using Beaufort. I'm looking for any advice on these two facilities or will by PCM even consider referring me to either. If I can't figure out something soon I may have to resort to Gastric Bypass at MUSC in Charleston. I had a very serious slip with the LapBand and I won't consider doing it again. I really need this surgery ASAP I'm gaining weight like mad and need help!!!

[Anjelika 14]

gingersnap~ you and I both are in the same anxious waiting game. I've signed myself up for a WLS program thru one of the hospitals here, but because Tricare doesn't cover VSG, I'll have to figure out what I want to do when I get to the end of pre-op. The other option, of course, is to just go thru a MTF. The MTF does have a program, but I honestly don't trust that hospital (which is the reason why I pay extra for Tricare Standard). I have been thru this particular civilian WLS program before, so I know what an AWESOME support system and healthcare I'll be receiving. I just don't know how I'd be able to afford it if I have to self pay.

[mellifrits 25]

I was super excited when I read the first post but was soon disappointed when I read the commits. I have Tricare and I have had the super sleeve aka (Gastric Plication) but now that I am two years post op the Gastric Plication is not helping. I am very much wanting to look into getting the VSG but I can't afford to pay for it out of pocket again. I live in Beaufort, SC right now. Does anyone know of a Military Dr that does VSG in my area?

[Anjelika 14]

I was super excited when I read the first post but was soon disappointed when I read the commits. I have Tricare and I have had the super sleeve aka (Gastric Plication) but now that I am two years post op the Gastric Plication is not helping. I am very much wanting to look into getting the VSG but I can't afford to pay for it out of pocket again. I live in Beaufort, SC right now. Does anyone know of a Military Dr that does VSG in my area?

I think gingersnap lives in SC and is looking for the same advice.