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Medicare Covers Sleeve

Renee B.
on 8/21/10 3:50 pm
VSG on 10/20/10 with
I talked to Medicare today.  It covers the VSG if you can prove you have not been successful at other weight loss attempts, BMI 35 (or above), and you have 1 obesity related illness such as hypertension or diabetes.  Of course, this is subject to approval and is no guarantee of approval, but CPT 43775 is definitely covered. 

Do you know any VSG drs that take Medicare? 

Thanks,
Renee
HW282 SW272 CW170 GW150 "I am allergic to carbs. They make me break out in fat.    
           
    
Tracey W.
on 8/21/10 4:26 pm
This is so confusing. I called medicare last night after the other post about it. They said they wouldn't cover it. Can this get more confusing???
Jagator88
on 8/21/10 5:11 pm - Jacksonville, FL
VSG on 06/04/09 with
Did you give them the code or just ask about weight loss surgery? I know sometimes it does make a difference.
5' 7" 244/95/125 SW/CW/GW
VSG by Dr. Miguel Zapata on 06/04/2009
Monterrey, MX
Hayley                    

                                          
Renee B.
on 8/21/10 6:15 pm, edited 8/21/10 6:15 pm
VSG on 10/20/10 with
I gave him the code, without even saying what the surgery the code represented. He told me it was for the Veritical sleeve gastronomy (haha) . ( He mispronounced it a little. ) I acknowledged that, yes, that is the surgery I was referring to.
HW282 SW272 CW170 GW150 "I am allergic to carbs. They make me break out in fat.    
           
    
KevinStopford
on 8/21/10 5:40 pm - Altamonte Springs, FL
 Tracey call again and give them the CPT code 43775.  Do you have original Medicare or one of the Advantage plans? Thanks. I wish you a good journey.

Kevin


          
               
KevinStopford
on 8/21/10 5:37 pm - Altamonte Springs, FL
 Hi Renee,

I called Medicare yesterday evening and they told me I was covered for CPT 43775.  I have Medicare only, not the Advantage plans. My insurance coordinator will let me know for sure around September 1st.  My doctor accepts Medicare only and Advantage plans for weight loss surgery. He does gastric banding, VSG, and gastric bypass.  Unfortunately my BMI is 47 with sleep apnea and GERD. But anyway, thanks for the post.

Best regards, 

Kevin
          
               
Renee B.
on 8/21/10 6:20 pm, edited 8/21/10 6:32 pm
VSG on 10/20/10 with
Oh, Kevin,
Thanks for your post yesterday. It is the reason I called about the surgery today. I have been planning to go to Mexico and was putting down $500 toward it this week, and now I am running down an entirely new rabbit trail. What a crazy journey this is becoming - trying to get the VSG!!!
HW282 SW272 CW170 GW150 "I am allergic to carbs. They make me break out in fat.    
           
    
Renee B.
on 8/21/10 6:32 pm
VSG on 10/20/10 with
Oh yeah- The Medicare guy I spoke to said Original Medicare Part B only is $110.50 a month for coverage with a $1100 deductible.  This is the standard rate for all.  Part A only covers $1233.13 toward the facility usage.  I think that means hospital stay.  I forgot to ask about that deductible if there is one.  I wonder if I would end up paying $6000 or  more over that limit just to bunk at the hospital for a couple of nights?!!!??

BTW- I do not represent Medicare, nor claim this is true.  I am just passing along what was told to me.  :p
KevinStopford
on 8/21/10 8:37 pm - Altamonte Springs, FL
Hi

I think you would only pay the $1100 deductible for Part A hospital stay.  If it is a Medicare approved facility, then the hospital has to accept what they get as paid in full.  Same for doctors.  This whole Medicare and VSG thing just boggles my mind.  It is crazy indeed.  I'll just wait on the insurance coordinator to call me back.  Best wishes to you.

Kevin

I do not represent Medicare.  Any information I post about Medicare is from the "Medicare and You 2010" handbook and can be found at the following website:

http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

Also you can visit medicare.gov and cms.gov for detailed information.
          
               
kakora
on 8/21/10 7:24 pm - FL
If Medicare does cover, this would certainly help get other insurances to cover for vsg surgery.. Hope this is all true.
Tracey W.
on 8/21/10 9:22 pm

I just called medicare back...but the system's down...oh well, I have to wait another day to find out.