Medicare And Gastric Sleeve.

[kimpossible67 608]

M on board for having rny but I'm wondering if Medicare now covers the sleeve? I'm in Michigan. Thanks!

[DLCoggin 1,788]

According to the U.S. Dept. of Health and Human Services, the sleeve has been approved as of June 27, 2012. The decision reads in part:

• 
  Medicare Administrative Contractors acting within their respective jurisdictions may determine coverage of stand-alone laparoscopic sleeve gastrectomy (LSG) for the treatment of co-morbid conditions related to obesity in Medicare beneficiaries only when all of the following conditions A-C are satisfied.
  
  1. The beneficiary has a body-mass index (BMI) ≥ 35 kg/m²,
     
  2. The beneficiary has at least one co-morbidity related to obesity, and
     
  3. The beneficiary has been previously unsuccessful with medical treatment for obesity.
     

You can read all of the information at http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=258&ver=2&NcaName=Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity&MEDCACId=26&IsPopup=y&bc=AAAAAAAAIBAA

It's been a long time coming but looks like it is here!

[kimpossible67 608]

Thank you. However my surgeons office still says no they don't.

[DLCoggin 1,788]

Thank you. However my surgeons office still says no they don't.

You might want to try to verify that independent of your surgeon's office. I know the government has been looking at this for months and a lot of folks have been waiting for a decision. It's possible that whoever you are talking to is unaware of the decision that is just a month old. You might want to let them know and give them the link. We all know that everything we see online is not always accurate but the link is to a .gov website and if it was an error, it's likely that they would have pulled it by now. Note that the announcement says "Medicare Administrative Contractors acting within their respective jurisdictions may determine coverage of stand-alone laparoscopic sleeve gastrectomy". That says to me that it's not an automatic approval but if you meet the requirements, I would think your chances are good. Good luck!

[kimpossible67 608]

Thank you, you are very kind and thoughtful.

[kimpossible67 608]

My insurance coordinator is saying no its not covered! Ugh!!!

[lessoflittlebit 8]

The sleeve isn't covered much in my state (KY) and my surgeons office doesn't use it unless you are at too high risk for RNY.

Louisville, KY ~ RNY June 2013 ~ Sent from my iPad using RNYTalk