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

[Cherrybomb 54]

I am finding this thread really interesting since I had my sleeve on 4/3/12 that was paid for 100% by my Medicare and Medicaid. I live in Florida and had my surgery at Shands at University of Florida in Gainesville. My surgeon was Dr. Caban (partner with Dr. Ben-David.)

[sdb1147 54]

Hi @Cherry bomb & thanks for the feedback. I wish Medicare/Medicare would get there stuff together in every state. Here in WA I'm being told that Medicare won't pay for vertical sleeve surgery, but will pay for the others. Apparently, vertical sleeve surgery is a relatively new medical procedure with not enough facts & findings...yet.

I've asked my primary care physician to forward a referral letter for me & now I have to come up with a million records of past weight loss attempts. I have no records to speak of other than memory of trying one failed diet pan after another for the past 20-30 years.

So, wish me luck. At least (on the positive side) it's a start. I plan on volunteering myself as a case study for the vertical sleeve procedure if it's data they want. I've studied the other choices & I've come to he conclusion that the vertical sleeve is the way to go.

I'll keep everyone informed as to my progress.

[Cherrybomb 54]

Hi @Cherry bomb & thanks for the feedback. I wish Medicare/Medicare would get there stuff together in every state. Here in WA I'm being told that Medicare won't pay for vertical sleeve surgery, but will pay for the others. Apparently, vertical sleeve surgery is a relatively new medical procedure with not enough facts & findings...yet.

I was shocked to find out that people in other states are being denied. From the first visit to my surgeon he tried to talk to me into the sleeve. I had originally went in for RnY. He told me that I was lucky to have insurance that would cover it, as many don't.

I ended up with the sleeve and am glad I did. i feel fortunate that is was covered after hearing others' stories. Good luck to everyone who is still waiting to be approved.

[sdb1147 54]

I just wish Medicare would treat every state the same wth respect to sleeve surgery. Why is it approved in some states & even recommended by doctors, yet in other states the only procedures recognized are the Lap-Band or Rou-en-y? However you spell it!

[sdb1147 54]

Majority of the times, I don't think my insurance reps even understand themselves. Lol

Anjelika, I'm from Hawaii. Originally from Hanalei, Kauai, but raised in Kihei, Maui most of my young life. I've been WA for 30+ years now.

If you or your husband is in the military, won't they pay for weight loss surgery?

Wish me luck on my journey, which continues...

[Anjelika 14]

Anjelika, I'm from Hawaii. Originally from Hanalei, Kauai, but raised in Kihei, Maui most of my young life. I've been WA for 30+ years now.

If you or your husband is in the military, won't they pay for weight loss surgery?

Wish me luck on my journey, which continues...

Cool! I'm born and raised on Oahu, but became a military brat so I spent a few years in WA as well.

For me, VSG will only be covered in a Military Treatment Facility from the info I've been gathering from VST. Tricare will cover RNY and the Lap-Band, but won't cover VSG.

As far as Medicare, us Tricare peeps are following the story because it seems that when Medicare begins to cover a procedure, Tricare follows (i.e. Lap-Band). I don't have Medicare, but I continue to follow the notes on VSG coverage in hopes that Tricare will begin to cover it as well. I guess I don't get the difference of what state you're in when it comes to Medicare coverage. I thought Medicare was Medicare. MEDICAID, on the other hand, I thought was state to state thing. Idk.

[Alexandra39 72]

Thanks Greg, for posting all this info and links. I am very disappointed as well because I found out today that my Medicare (primary) and Medicaid (secondary) won't cover VST. Does it vary from state to state? I'm in NY. I had also begun the process of gathering the necessary documentation for this surgery thinking that by August or September this would be approved. Unfortunately, it turns out that the hospital I went to provided me with the wrong information on some printed insurance information material they had provided me. It was a bad experience with the insurance coordinator because it almost sound as if she did not want to help. She was quite blunt and interrupted me many times while I was trying to ask questions. It was very frustrating.

They want to charge a $250 fee for a psychological evaluation and $250 for the nutritionist. I understand all hospital are different and this hospital is considered one of the best for Lap Banding Procedures and Bariatrics in general. However, given the fact that I am on Medicaid and Medicare an insurance coordinator can probably understand that I have low income. When I mentioned that I see a psychotherapist and psychiatrist for depression, she said that a psychiatrist and psychologist are 2 very different things. She did not got on to at least briefly tell me how. she said they needed someone who has experience working with bariatric patients. I told her my psychotherapist and psychologist have both worked with bariatric patients. She said in that case what I could do is to have them write a very detailed letter of my situation and the reasons they feel I should have surgery. I asked if there was a form they needed to fill out or speific questions they needed answered and she said now because everyone is different. (Obviosuly!) The she said that they would review this letter to see if it was acceptable. Let me just say, this just really upset me. I didn't think it would because I know it's a waiting thing and I can do that. But when you're mentally ready for something that is such a big deal because it is life changing and for the first time in a long time you feel focused and are taking all the necessary steps to make it happen and then you find out not only that the surgery may not even be approved in the end but you also receive that kind of poor, dismissive treatmenr from someone who is supposed to help...well...it did end up getting to me. I have been keeping a food and execrcisediary for about 3 weeks so fara and I ahave been doing well practicing for post op lifestyle...today I did not do well. I've been hungry all day and I think it's the frustration of this.

Well, I guess I'll have to snap out of it and just be patient.

[sdb1147 54]

@MariNYC. Hang in there and keep your chin up. I share your frustration. I cannot understand why/how Medicare will not approve sleeve surgery, but they approve a much more complicated one: Rou-en-Y (?). Much more complicated surgery and one that forces individuals to consume multi-vitamins & supplements the rest of their lives because the surgery by-passes at least half of the digestive system. I might consider Lap-Band as my Plan-B, but I'm still focused on the Vertical Sleeve surgery. Don't like the fact that a foreign object is being place in the body.

I received a call from Swedish Hospital here in Seattle, WA informing me that my weight loss surgery had been approved. I'm waiting for my primary care doctor to forward a referral letter, then I'll seen what happens from there.

In the meantime, don't give up. Journal. Put your thoughts down in a notebook (I'm keeping my thoughts/notes on a steno pad). After you've entered your thoughts/input, leave them there...in the notebook. Don't carry around all that 'stuff'.

Keep this thought in mind, the Lord is always watching over you.

God bless.

[Alexandra39 72]

Again, thanks so much for your support. It sure does mean a lot. I lost sleep last night over this and I also went over my calorie intake. I have to get back on track and trust that God will know what's best for me.

Good idea about the journal. I will start one soon.

Good Luck to you & God Bless.

[sdb1147 54]

Received a call from my primary care doctor's office yesterday. Dr. M has completed my referral letter for gastric surgery and faxed it to the hospital. Hope I hear back soon Still waiting to hear anything about Medicare paying for the procedure. I'll know & learn more when I get my first counseling at the hospital.

[sdb1147 54]

I contacted Medicare, again, to inquire about any updates they might have with respect to the vertical sleeve procedure, and once again I ended the conversation in frustration. I'm talking apples & the representative was talking oranges. Typical government speak.

I kept asking about vertical sleeve & she kept saying Medicare does cover weight loss surgery.

In the end, she actually asked me if I was a medical provider. After clarifying the fact that I wasn't a provider, she suggested I check with the doctor doing the surgery if in fact the surgery I'm asking about is covered. Why can a doctor get the answer, but not me, the patient?

I'll discuss with the doctor at Swedish Hospital when I go for my initial appointment.

[Anjelika 14]

sdb,

I'm sorry you're going through all that frustration. Have you read the initial posts on this thread? There's a link straight to the info about the current status of Medicare and Vertical Sleeve Gastrectomy. If you read it, it will explain why Medicare does not cover VSG at this time. It also goes on to say that it will cover it if it's part of a clinical study. In June, there will be a final decision about the coverage. Please take the time to read it. The info is there for you instead of getting nowhere by calling them and then having extra frustration.

[Cherrybomb 54]

sdb,

I'm sorry you're going through all that frustration. Have you read the initial posts on this thread? There's a link straight to the info about the current status of Medicare and Vertical Sleeve Gastrectomy. If you read it, it will explain why Medicare does not cover VSG at this time. It also goes on to say that it will cover it if it's part of a clinical study. In June, there will be a final decision about the coverage. Please take the time to read it. The info is there for you instead of getting nowhere by calling them and then having extra frustration.

I think it's hard for him to accept since some people, myself included, have had Medicare & Medicaid pay for VSG. They can put whatever information they wish on the internet, but those of us who have had this surgery paid for know it's not accurate.

When I contacted Medicare initially about WLS, I was told they cover gastric bypass. I opted for that surgery and only found out through my surgeon that the sleeve is covered.

[sdb1147 54]

I think it's hard for him to accept since some people' date=' myself included, have had Medicare & Medicaid pay for VSG. They can put whatever information they wish on the internet, but those of us who have had this surgery paid for know it's not accurate.

When I contacted Medicare initially about WLS, I was told they cover gastric bypass. I opted for that surgery and only found out through my surgeon that the sleeve is covered.[/quote']

It's not a matter of being disappointed that any of you have had Medicare pay for your sleeve surgery. What I don't understand is why pay for someone living in one area/state but not in another.

[gmanbat 5,889]

Sorry is this is redundant but I just got an e-mail from my surgeons nurse, a forward from the American Society for Metabolic and Bariatric Surgery. It's a call to action to advocate for the sleeve to the bureaucrats who decide this.

Here is their letter to the CMS: http://s3.amazonaws....ISION-FINAL.pdf

Here is a guide to advocacy for the surgery: http://www.obesityac...nsideration.pdf

Here is the Obesity Action website on the coverage decision: http://www.obesityac.../advocacy-alert

We can make a difference for people who need this.

EDIT: Apparently the CMS website was only accepting comments up to Apr. 28. Sorry I got this to you late. I just learned about it this morning.