Help! I Was Having A Good Day But Now I Hear This...my Insurance Won't Cover My Surgery

[Alexandra39 72]

So, after being so optimistic about this entire thing...I call my surgeon today to ask a few questions about paperwork and she tells me that my isurance (Medicare) does not cover sleeve gastrectomy. What?! I have printed material given to me by her office that states that it is. What's the deal? I'm so confused. Not to mention the insurance coordinator wasn't the friendliest person I've met. So I have an appointment on Wednesday to see the nutritionist first (to whom I have to pay a $250 fee non-refundable) followed by an appointment with the surgeon. I think I will ask to see the Doctor first and get things cleared out with her insurance coordinator. All the insurance coordnator told me was that it is not approved and that is it pending approval possibly by the summer. This is frustrating.

I called Medicare to ask and they said sleeve gastrectomy was not on their list of approved procedures. I asked if there was any information in their system that states the status of approval or something of the sort and they had nothing. Does anyone know where else I might be able to find out?

Does anyone know anything about this?

Please let me know if you do. Thanks.

[4ALongerLife 329]

Call the insurance coordinator back and ask him/her what the next steps are. I have a feeling they probably have done this before and you might be worrying for nothing. (so I hope!) Best of luck!

[Cherrybomb 54]

I have Medicare & Medicaid and just had the sleeve on 4/3. My Medicaid picks up for all the things not covered by Medicare so I'm not sure which one actually paid for it. I do know that my surgery never costed me a dime. I didn't even have co-pays for appointments.

In my case, at least, it was in their best interest to cover it. For years I have been taking over $3,000 a month in prescription drugs. I'm down to taking only 3 now that total less than $300 a month.

[Alexandra39 72]

I have to pay $250 for the nutritionist and another $250 for the psychologist. I'm going to look in to another hospital and see what they say

[Alexandra39 72]

and thanks...I'm so glad and relieved to hear that Medicare covered you. Apparantely, my Medicare is my primary insurance and Medicaid is secondary. It looks like it's the same for you.

[Cherrybomb 54]

and thanks...I'm so glad and relieved to hear that Medicare covered you. Apparantely, my Medicare is my primary insurance and Medicaid is secondary. It looks like it's the same for you.

Yes, that is exactly what I have. You shouldn't have to pay for anything. Mine covered everything. Maybe they are not trying to charge Medicaid, only Medicare? I would try another place and point out that you have Medicaid also.

Edited to add:

I did have to find my own psychologist that took Medicaid. If I had used the one my surgeon generally works with, I would have had to pay out of pocket. I just found one that accepted Medicaid and got them to do my evaluation and send my surgeon the report.

[helleva 22]

Hi, just wanted to give you some hope. My best friend is on medi-cal and she has been approved for surgery. Its a little longer process because everytime she needs something (tests, psych eval., meetings) she needs a referral for it. She's five months into her journey and should have her surgery late May or early June (total of 6 months). Another great thing for her I she pays absoulutely nothing out of pocket. I know medi-cal is different from medicaid but its also state funded.

[paulsgirl1297 18]

So' date=' after being so optimistic about this entire thing...I call my surgeon today to ask a few questions about paperwork and she tells me that my isurance (Medicare) does not cover sleeve gastrectomy. What?! I have printed material given to me by her office that states that it is. What's the deal? I'm so confused. Not to mention the insurance coordinator wasn't the friendliest person I've met. So I have an appointment on Wednesday to see the nutritionist first (to whom I have to pay a 250 fee non-refundable) followed by an appointment with the surgeon. I think I will ask to see the Doctor first and get things cleared out with her insurance coordinator. All the insurance coordnator told me was that it is not approved and that is it pending approval possibly by the summer. This is frustrating.

I called Medicare to ask and they said sleeve gastrectomy was not on their list of approved procedures. I asked if there was any information in their system that states the status of approval or something of the sort and they had nothing. Does anyone know where else I might be able to find out?

Does anyone know anything about this?

Please let me know if you do. Thanks.[/quote']

I have CIGNA insurance and when I called to see if the sleeve was covered she told me no because it was so new, so I told the insurance coordinator and she said hmm that's weird they've covered for other patients.. So she called and they told her that yes it was covered.. Maybe ask for a different person or give them the ICD-9 code for the sleeve procedure, and if they still say now get your medical doctor to write a letter about how it will improve your health and then find some stories and medical statistics on how the surgery improves medical conditions and in the long run is cheaper for Medicare and insurance companies and mail it to the Medicare coordinator

[Alexandra39 72]

I spoke to them today and they told me that Medicare has not approved Sleeve Gastrectomy and the review in able was not favorable. I'm so disappointed. Here I am getting my paper work together and everything and now this. At this point I'm unsure what to do. I tried to find out when the final decision will be made. I hope that they approve this. I'm really surprised they didn't here in NY and in Florida they do.

[Alexandra39 72]

I just spoke to another hospital and they told me the decision will be made in July. I guess I'll have to wait.

[Wheetsin 714]

Look at this post/thread, it may help: http://www.verticalsleevetalk.com/topic/32625-rejoice-medicare-medicade-coverage-for-vsg-is-currently-under-medical-review/page__p__285036#entry285036

[Cherrybomb 54]

I just spoke to another hospital and they told me the decision will be made in July. I guess I'll have to wait.

Maybe my Medicaid paid for it. I honestly don't know for sure since I always present both. Have you checked into your Medicaid coverage? Usually Medicare pays for much more so I assumed they paid for the bulk of it, but maybe not?

[paulsgirl1297 18]

I spoke to them today and they told me that Medicare has not approved Sleeve Gastrectomy and the review in able was not favorable. I'm so disappointed. Here I am getting my paper work together and everything and now this. At this point I'm unsure what to do. I tried to find out when the final decision will be made. I hope that they approve this. I'm really surprised they didn't here in NY and in Florida they do.

My cousin has Medicare and was told they don't pay for the nutritionist appointments ? Do you know if they do or is it a case by case thing

[Alexandra39 72]

My cousin has Medicare and was told they don't pay for the nutritionist appointments ? Do you know if they do or is it a case by case thing

At NYU you have to pay for the nutritionist. A one time fee. It varies by hospital.

[Cherrybomb 54]

They covered all the nutritionist visits for me so far, but last time I was there I was told they are no longer going to be covering it. I have to pay $40 per visit going forward.