Medicare Approval For Gastric Sleeve?

[stanzi 1]

All summer I've followed this, but been frustrated by the lack of knowledge. The committee approved the VGS on June 30, but then a committee or such was formed and now it's being discussed and getting feedback? Decision due in November? Anyone heard anything about this? I'm eager to make the leap, but not without insurance!

[kjntwins 59]

I was approved for my sleeve. My surgery is December 17th 2012. I have Medicare with Humana Gold as my supplement.

[stanzi 1]

Thanks for the info! I have Medicare A & B and BlueCross/BlueShield as secondary. I called Big Blue and they said that if Medicare declines, that Blue Cross/shield would approve.

Okay, that's good. The insurance gal at the Dr. has said that Medicare won't tell us if they'll approve.... that they give determination after the operation. That can't be right! So I called her and gave all the pertinent information and set her back to it.

Back in '08 I had the Lap Band. BC paid for it. Was a breeze. Lost weight. Last year, erosion set in. Major infection. I almost died. I'm slowly gaining the weight back. I like the restriction that the lap band gave me. Naturally I wouldn't choose a Lap Band again, but the VSG has been touted by many, and I've met a couple who are happy with the outcome. Rue en Y is too radical for me, rerouting plumbling and all, so VSG seems the happy answer. Now, just to work out the finances.

Wish you all the best in your upcoming surgery!!

[keya34 46]

I was approved for my sleeve. My surgery is December 17th 2012. I have Medicare with Humana Gold as my supplement.

How long from submitting ur paperwork did u gey approved? I have that insurance. Please any information is helpful.

[keya34 46]

I was approved for my sleeve. My surgery is December 17th 2012. I have Medicare with Humana Gold as my supplement.

How long from submitting ur paperwork did u gey approved? I have that insurance. Please any information is helpful.

[stanzi 1]

kjntwins: Thanks for the info.... Is your Medicare picking it up or is your secondary? I ask because the insurance person at the Dr. is saying that Medicare isn't paying yet (or approving) and that Nov. 12, 2012 is the day that the final, final determination comes around. I'm curious how your insurance was handled.... Maybe your Dec Surgery date is scheduled out so as to allow for approval by Medicare?

[stanzi 1]

keya34: I had a Lap Band (later taken out) and it always takes longer than you want for the paperwork and especially jumping thru the hoops they have, e.g. dietary, Psych, orientation. Be patient. It will come. You probably already know this, but gastric surgery is only a dietary tool. It isn't going to change you like turning on a switch. You will still have to pass on the desert and malteds (if that's ur weakness) and do the regular exercise and eating healthy. Especially staying away from most anything that's white. The best thing is that surgery helped me curb my appetite. It restricted how much I could eat. Oh, if you chew real good, and wash it down with liquid, you could defeat it, but why do that? You're going under the knife, risking your life. Use this as a tool to achieve your goals! For me it was great. My lap band kept me down. But I got erosion and the infection liked to darn near kill me. I'm not going back there. VSG is what I wanted anyway, now I have to wait and see what insurance is going to do.... Good luck!

[keya34 46]

keya34: I had a Lap Band (later taken out) and it always takes longer than you want for the paperwork and especially jumping thru the hoops they have' date=' e.g. dietary, Psych, orientation. Be patient. It will come. You probably already know this, but gastric surgery is only a dietary tool. It isn't going to change you like turning on a switch. You will still have to pass on the desert and malteds (if that's ur weakness) and do the regular exercise and eating healthy. Especially staying away from most anything that's white. The best thing is that surgery helped me curb my appetite. It restricted how much I could eat. Oh, if you chew real good, and wash it down with liquid, you could defeat it, but why do that? You're going under the knife, risking your life. Use this as a tool to achieve your goals! For me it was great. My lap band kept me down. But I got erosion and the infection liked to darn near kill me. I'm not going back there. VSG is what I wanted anyway, now I have to wait and see what insurance is going to do.... Good luck![/quote']

You r so right its not a cure all but its a help all at least for me. And I do have to leave my favorite thing in the whole world alone cause I have no kind of restraint oreo Cookies and chocolate chip with out the chocolate. I will always love u even though we must part for now. I also must remember to eat and not skip meals to come back later to eat the whole house. Saying this I have started praying and ask that you all pray for me to. I hope my ability to follow orders work. This will only be my 2nd time under the care of a doctor the first while preggo witj my little girl only picked up 22lbs unlike my boys 64lbs.

[stanzi 1]

You're off to a good start then! You're going for the VSG? Then you know that it removes a lot of the stomach that produces the "hunger hormone". But if I were you, I'd plan for tackling the Oreo attraction.... IF, and I say "IF", your surgery does the trick for hunger, you are still going to be in love with Oreo s. I wonder, if your hunger were satisfied, would you be able to turn down an Oreo or just have "one"? Nibbling it slowly, and savoring every morsel of taste? Hell, you don't have to have the whole box, and that's what behavior modification is all about. Sometimes it may be easier to say "no" instead of having to use restraint. But if you have the surgery, you have a darn powerful tool to help you to have restraint!!

It's such a paradox..... that we enjoy such abundance, and that people around the world, and even in our OWN country, don't know where their next meal is coming from....

And we are grateful that we live in such a time of abundance! We pray that others may be as lucky as we are!

Back to the subject; You know how hard it is to lose the 'baby fat' and as we age, the metabolism slows, naturally making weight gain easier.

The VSG is rather radical as opposed to the lap band, but even if the VSG were to not be enough, as you already know, you could elect to go for the full duodenal switch and go the full magilla. But then, I don't know what your BMI is and how much you need to lose. Point is, Surgery, is just one tool in the tool box of options for us to choose from in order to cope with the plethora of food we have at our beck and call.

Tonight in the Supermarket, I was marveling at what we have, so close and at our reach. Basic food, prepared food, frozen, even hot, ready to eat. And you'll drive past fast food franchises on the way there and back. Are we food obsessed???

Yep.

So don't feel like you're lacking in any way because you are uncomfortable being overweight.... It's miraculous that everyone isn't 200 lbs overweight! We're not a food oriented society, say like France, where they savor food and look to their Chefs, like our people look up to sports stars! It's all dollar driven, and Big Bucks Food Industries box it, bag it, freeze it, and sell it to us on tv, in magazines, on billboards, in newspapers, heck, even on the internet! We are the first, biggest and best consumer society in history! An experiment in action!

I'm rambling, but I think what I'm saying is that moderation is the key. Anything anyone can say about "DIET" is

"Calories in, Calories out." that's it. Anything I, or anyone else could say is an elaboration of that. And surgery is just another tool to help YOU regulate those calories.

I'll pray for you. But you are the one who'll carry the load.... And you can do it! You're making antother step helping yourself towards achieving the life you want to lead....

[keya34 46]

I am taking everything to heart andy brain it was all well said. Me and my doctor did talk about the next step if all my weight does not come off. I am 5'5 and bmi is 52. I know I can lose the weight with the help of the sleeve, and talking with someone who know what there doing to guide me. I am human so I know I will stumble but I do listen and take good advice. Lol Momma didn't raise no fool lol A hard head makes a soft behind. Tell me once I listen that's how I was raised down in texas lol. So believe me when I say thank you.

[kjntwins 59]

Humana Gold is covering all of it.

[kjntwins 59]

I started the process in May. The office I used is very busy, so appts are made out in months advance. It really only took 2 months to get everything going. And when I finished all my steps the dr faxed my papers to Humana and it was approved within 2 days.

[keya34 46]

I started the process in May. The office I used is very busy' date=' so appts are made out in months advance. It really only took 2 months to get everything going. And when I finished all my steps the dr faxed my papers to Humana and it was approved within 2 days.[/quote']

Thats nice yo hear because thats what I have did u only pay 225 for ur copay at the hospital? (for each day ur there)

[kjntwins 59]

This is how I understand about Humana/Medicare. I have to use the same standards at Medicare. Medicare pass the law on the sleeve, as case by case. Humana now allows it. I have to use the Hospital and Surgeon of Excellence just like Medicare.

[keya34 46]

This is how I understand about Humana/Medicare. I have to use the same standards at Medicare. Medicare pass the law on the sleeve' date=' as case by case. Humana now allows it. I have to use the Hospital and Surgeon of Excellence just like Medicare.[/quote']

Me too when I get approved. If you dont mind me asking did u have to be under the care of a doctor for weight loss or did u have a comorb.?