Sleeve surgery, approved, by, insurance,?

[Oregondaisy 2,021]

You should try getting into the chat room . there are always people in there at various stages. Some will have just had Lap Band surgery, and there are some that have had it awhile and just love it.

[LAN2k 0]

Thanks Elisabeth, yes I searched this thread out because I want to hear it from people who have the experience. As the reality of being banded draws nearer I continue to lose sleep at the thought of actually going through with it. And I keep researching. I learned about the Sleeve Gastrectomy and it just seemed logically sensible and safer. I don't get the jitters when I envision myself having that procedure done on me..but I literally wake up at night with thoughts of the things that can and do go wrong with the Band.

[LAN2k 0]

You should try getting into the chat room . there are always people in there at various stages. Some will have just had Lap Band surgery, and there are some that have had it awhile and just love it.

Thanks I will.

[Elisabethsew 50]

Thanks Elisabeth, yes I searched this thread out because I want to hear it from people who have the experience. As the reality of being banded draws nearer I continue to lose sleep at the thought of actually going through with it. And I keep researching. I learned about the Sleeve Gastrectomy and it just seemed logically sensible and safer. I don't get the jitters when I envision myself having that procedure done on me..but I literally wake up at night with thoughts of the things that can and do go wrong with the Band.

I find that people either have problems right away with the band or a few years out. It's considered the safest weight loss surgery and is the least invasive in terms of procedures. All weight loss surgeries require learning to eat healthier and adopting an exercise plan so none are guaranteed. I guess the big decision for you to make is waiting for sleeve procedures to gain approval versus not waiting and having the band placed.

When the band failed me, the U.S. surgeons wanted to place another band or see about getting me approved for the bypass. I don't absorb Iron and get intravenous Iron treatments when my ferritin is low. Malabsorptive procedures are not in my best interest. Self pay in the U.S. for sleeve surgery was quoted at $25,000 for the surgery and a one night hospital stay.

I used saving and borrowed money from my sister to have surgery in Mexico. A virgin sleeve is $9000.00 and a revision is $12,500 with Dr. Aceves. That included the transportation to and from the airport, the hotel stay, the transportation to the hospital, pre-op testing, the surgery, medications, and a three night stay in the hospital. It was a big expense for me and it was hard for me to spend that money on myself but I deserved a better quality of life. I don't regret my decision.

[WASaBubbleButt 41]

If you don't have a slip or an erosion, you have to start a "paper" trail of problems. I was told that the acid regurg. and inability to sleep lying down would require about 9 months of MD documented visits before insurance would "consider" paying for the band to be removed and revising to another surgery.

This is horrible...I can't believe to what extent some of you have had to go to and through to finally get to a place where you can lose weight with securtiy. I'm literally choked up here. I am in LI, NY so far I've been told "no" to the Sleeve by the doctor(who considers the Sleeve "experimental" and doesn't do it), who would do the Lap Band surgery on me, (if I am approved...(35BMI with co morbidity factors...)Ins.- Medicare). His secretary told me that medicare will not approve the Sleeve. I do want weight loss surgery scared as I am because I have been around the try-to-lose-weight block so many times that I finally am willing to sacrifice part of my anatomy! I need help. I am feeling pressured due to insurance "approval" issues to take what I can get, either Lap Band or Gastric Bypass. I am not in a position to self-pay nor take out a loan. I am so frustrated. The more I read about being "banded" the more I want to get the sleeve...the more desperate I am becoming. Thanks all for such sincere posts, my heart goes out to you with wishes for victory in the restoration of your bodies to their perfect weight with incredible health and longevity.

If the only reason you are unable to get a sleeve is because that doctor doesn't do sleeves, go to another doctor.

If Medicare will not approve it in the near future then what if you get a band? Then if you can lose weight and get healthy would you be able to afford to self pay for a revision if need be?

If you get RNY and need a revision there is little you can do. You can bypass more intestine or get a band after bypass.

So if there is a chance in the world of self pay in the future get a band now in case you need a revision then you can revise to a sleeve.

With that said, how will you get approval with a BMI of 35 and no comorbids?

[schatzie 0]

I understand you, and the worst is if you have the bypass and you have an accident, is going to be very difficult to keep you nurture since your stomach doesn' absorb that much.

[WASaBubbleButt 41]

I understand you, and the worst is if you have the bypass and you have an accident, is going to be very difficult to keep you nurture since your stomach doesn' absorb that much.

One point I did not make clear and I regretted it as soon as I hit send (although this is not necessarily responding to your comment but just something I should have qualified) is that I am NOT a fan of revision. I'm a fan of picking the right surgery type for you the first time around.

But if losing weight would get you to a healthier place where you could eventually afford a sleeve if ins would not pay for it then banding could afford you weight loss and IF you suffer complications then revise to what you actually want?

If you get bypassed then that is your surgery forever. There are a handful of surgeons that can take down the RNY and do DS but it's not a promise that you would be one of those people. If you get a band you can revise to anything you want if the need arises.

I view bypass as a necessary evil like chemotherapy. I hate chemo but in some people they have to have it. I hate malabsorption but some people have to have it. I consider myself more than lucky that I'm good to go with restrictive techniques alone.

[bcullum 0]

I have been approved and will have my surgery on April 28, 2009. Can't wait!!!

[Elisabethsew 50]

I have been approved and will have my surgery on April 28, 2009. Can't wait!!!

Congratulations! You're only a little more than a week before you're surgery.

[Oregondaisy 2,021]

I will be having surgery the day after.

[LAN2k 0]

Elisabeth, thanks for sharing your experience. I do have a dilemma here to grapple with. I very much want to get it right the first time. I just don't know how much longer I can hold out, which is why I am continuing to learn as much as I can. I am very glad you were resourceful enough to take care of your needs as you did. I hope to have the privilege to follow your progress. Thanks again.

[LAN2k 0]

If the only reason you are unable to get a sleeve is because that doctor doesn't do sleeves, go to another doctor.

If Medicare will not approve it in the near future then what if you get a band? Then if you can lose weight and get healthy would you be able to afford to self pay for a revision if need be?

If you get RNY and need a revision there is little you can do. You can bypass more intestine or get a band after bypass.

So if there is a chance in the world of self pay in the future get a band now in case you need a revision then you can revise to a sleeve.

With that said, how will you get approval with a BMI of 35 and no comorbids?

Although I don't know yet if I will be approved, I do have comorbids. Although my BMI is a 35 the weight is stifling my health, livelihood and well being. For the first time in my life I am realizing the ill effects my excess weight is having upon my body, inside and out. I really would like hold out and have the Sleeve Gastrectomy and not have to undergo a revision surgery, which I think would be enivitable if I were to have the band initially. I am still searching facilities and weight loss surgeons in the NY vicinity that do perform the Sleeve surgery to see if possibly medicare or a medicare plan will cover it. Your feedback is very much appreciated. Thank you.

[k_podski 2]

So... I have been lurking here on the VSG thread now for a while. You guys have posted so much useful information, and have definately struck some curiosity in me!

I was banded just over a year ago, and have a love hate relationship with my band. I have had several fills and unfills trying to get to the right spot for me. I think I am about there now, although I am still hungry. As I always have been. I am at the point where I mostly eat mushy types of foods. Not many types of normal foods agree to go down. In the morning I am usually so tight I can't eat. Breakfast is usually coffee, which sometimes, even that gets stuck. By mid morning I can usually eat breakfast very carefully.

I am currently working closely with the nutritionist from the bariatric center where I had my surgery. I feel like there is no happy medium for my restriction. Either I am loose, starving, and can eat a cow, or I am tight, starving, and can barely drink. Either way I am HUNGRY. All the time.

I have done so well with keeping on track, logging food, and making good choices. I admit I slack on "exercise" but I am a fairly active person, always go go go, out and about. I feel stuck in a rut. I think I need something other than the band...

I may have the option of getting the sleeve if I look more into the financing, but I am still unsure about the process. I also question my insurance. I have been told several times that Harvard Pilgrim is one of the quickest and easiest companies to work with. As of last October they said they do not cover VSG. Is it possible to challenge them? Or bring info to their attention?

Also I'm curious with the VSG if things get "stuck". I've read posts about still having to chew chew chew.. I am so over being stuck and spending hours in pain, in the bathroom, waiting for things to come up or go down!

I guess that's enough for now, sorry about writing a book on here! I've been curious for a long time, and just finally got the nerve to ask some of my many questions.

Thanks in advance for your time and knowledge,

Kerri

[WASaBubbleButt 41]

So... I have been lurking here on the VSG thread now for a while. You guys have posted so much useful information, and have definately struck some curiosity in me!

I was banded just over a year ago, and have a love hate relationship with my band. I have had several fills and unfills trying to get to the right spot for me. I think I am about there now, although I am still hungry. As I always have been. I am at the point where I mostly eat mushy types of foods. Not many types of normal foods agree to go down. In the morning I am usually so tight I can't eat. Breakfast is usually coffee, which sometimes, even that gets stuck. By mid morning I can usually eat breakfast very carefully.

I am currently working closely with the nutritionist from the bariatric center where I had my surgery. I feel like there is no happy medium for my restriction. Either I am loose, starving, and can eat a cow, or I am tight, starving, and can barely drink. Either way I am HUNGRY. All the time.

I have done so well with keeping on track, logging food, and making good choices. I admit I slack on "exercise" but I am a fairly active person, always go go go, out and about. I feel stuck in a rut. I think I need something other than the band...

I may have the option of getting the sleeve if I look more into the financing, but I am still unsure about the process. I also question my insurance. I have been told several times that Harvard Pilgrim is one of the quickest and easiest companies to work with. As of last October they said they do not cover VSG. Is it possible to challenge them? Or bring info to their attention?

Also I'm curious with the VSG if things get "stuck". I've read posts about still having to chew chew chew.. I am so over being stuck and spending hours in pain, in the bathroom, waiting for things to come up or go down!

I guess that's enough for now, sorry about writing a book on here! I've been curious for a long time, and just finally got the nerve to ask some of my many questions.

Thanks in advance for your time and knowledge,

Kerri

A couple of times I have seen people with sleeves excluded win an appeal but to be honest, it isn't very often and it's a long drawn out process. Point being, start now.

I chew better than before WLS but a LOT less than with a band. With banding you have to chew to a paste. With a sleeve you chew like a normal person. I've never been stuck and the times I've vomited were due to a learning curve with the sleeve. Little things are different. I think I have vomited 4 times in 10 months. That's a big difference from 3x daily with a band.

[LAN2k 0]

Would anyone here happen to know the Procedure Code for the Vertical Sleeve procedure? I have contacted Oxford Medicare to make inquiry and need the procedure code.