Ny Waiting For Medicare Approval

[babygirl_sandy 85]

I printed out the report and faxed it over to the surgeons office and she just called me, (in a sweeter voice.. Not annoyed) lol and stated that they are taking action and are calling medicare to find out an effective date so they can proceed with processing my paper work.. So you might want to do that.. She seemed a bit more helping then this morning.. Hope this helps.. Fingers and heart crossed!!

Sent from my SPH-D710 using VST

[Alexandra39 72]

I just called Medicare. So far they do not have anything updated on their system stating that Medicare did approve VSG. There are only still 3 approved surgeries on the list. The Gastric Bypass, The Pancreatic surgery (sorry I forget what it's called) and the Lap Band. I think I am just going to wait until I see the surgeon on the 6th to know for sure. One way or another, I'm getting surgery! I can't take the waiting anymore! I'm so mentally prepared for it and I don't want to lose my determination.

[lovealways 22]

Anyone know if straight medicaid in NY approves VSG??!

[newme0617 6]

I am thinking it will take a bit of time for the info to trickle down to a person answering the phone at Medicare..but from what I read, it has been approved...

[newme0617 6]

I had lap band 4-18..the port got infected and I had the total system removed on 6-16...I had lost 18 pounds, and now i have to wait 3 months to get the lap band reinserted....so with this sleeve being approved.. I plan on going with sleeve...

I lost weight down to a BMI of 34.8..need BMI of 35 or greater...for Medicare to pay!!

Doctor's office for me to gain 9 pounds to qualify for surgery again!!! I had to laugh and then cry....so I may be on my own as far as further weight loss unless I GAIN weight..

[Greg_P 9]

As newme0617 pointed out, this coverage decision is so new that it has not yet made it's way into the system Medicare phone reps work out of. Don't bother calling them, instead contact your hospital's Bariatric Coordinator. Additionally, coverage for VSG will be determined "case by case" at a local level. So VSG is covered, but not for everyone at a national level like the RNY or Lapband is.

I Spoke directly with my Bariatric Director this afternoon about Medicare's VSG decision. She reviewed the CMS memo decision and agreed with my interpretation that this decision was a good one and coverage appears imminent. While the "fine" details for Medicare contractors (ie hospitals) have not yet been released (billing code, guidelines for submitting, etc) she did say everything looks like a go and I will be the first patient she submits for Medicare approval next month!

For those of you who have not yet had the opportunity to get a personalized nod of approval from your hospital, read this and you should feel better. This is a summarized analysis and decoding of CMS's VSG memo from The American Society for Metabolic and Bariatric Surgery (ASMBS). A true authority in all matters concerning Bariatric's.

http://asmbs.org/2012/06/access-to-care-alert-the-cms-final-decision/

At long last the wait is over! If you have state (MA) Medical Assistance (Medicade) this is good news for you as well. With very few exceptions, coverage and requirements for Medicade mirror that of Medicare. I suspect that state MA will recognize the VSG no later than October when coverages for all states go through their annual update.

If you have not already begun taking the necessary steps to complete the requirements to be submitted for Insurance approval, NOW is the time to get started!

[mokee 588]

All medicare persons waiting. I'm in Ohio. Talked with my doctors insurance person this morning. He did receive the info from Medicare but it is not a cut and dry thing. He said It is still a state by state determination on a one on one basis. He said after my surgery he will submit to medicare with the determination and hope for the best. He said they can not submit until after the surgery so you don't know if they are going to pay or not. With the O'Bama medical thing passing the first step, we had better hope we all get our surgery before that takes over and we wait in line for years for every procedure we need. Best of luck to all of you waiting and I hope if anyone hears anything different please post the news.

Thanks

[Unobaby 5]

@mokee Im also in ohio and i've talked to my financial secretary thats submit paper work at my surgeons office and she actually called me and let me know it was approved if you met all the requirements, and also she said that medicare system hasn't been updated yet but as soon as they do update you can get submit your paper work

[newme0617 6]

"In addition, in the Top 5 on the 5th July 2012 newsletter from ASMBS, the Access Committee will provide additional instructions as to how you and your patients can help in the effort to achieve coverage in each particular region of the country. This again demonstrates our future need to work together in regional collaboration".

I thought MEDICARE was a national system, did not know that it would be regional or could be regional...Medicaid I know is regional.

Just confused here....I live in FLORIDA so our process if this is true will be stalled as ou GOV has been making cuts in Medicaid...I am on MEDICARE...

I had a lap band and it got infected....I had it done in Nevada, as I had a friend out there...I was not told I had to get approval from the state of Nevada , nor have I heard while researching in Florida that this was going to go thru the state for approval..

Oh well....will wait, as I emailed my doc;s office

[Kiwi/Nanci 9]

happy dance happy dance ....my Doctor called today to say yes medicare says ok surgery next weeeeeeekkkkkkkkkkkkkkk....

[Kiwi/Nanci 9]

happy dance happy dance ....my Doctor called today to say yes medicare says ok surgery next weeeeeeekkkkkkkkkkkkkkk....

[newme0617 6]

What state do you live in purenzr?

[Kiwi/Nanci 9]

I live in California