KevinStopford

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My weight has come down a little since last summer.  I have been following a vegetarian diet and also doing Power 90.  So we shall see how long this lasts.  I added running about two months ago and that seems to move the scale downward although quite slowly.  Medicare has not approved VSG for 2012.  So I am on my own once again to lose all this weight.  I still have about 115 pounds to go.   Take care.  Update in March right before leaving for Switzerland.

It has been almost a year and Medicare still hasn't approved Vertical Sleeve Gastrectomy.  I have lost all interest anyway.  So it is on to January 2012 to see if they will finally offer some hope.

So my insurance coordinator called me back today to say that the surgeon's office will not go forward with my sleeve gastrectomy.  I have original Medicare.  Medicare keeps saying yes we cover VSG.  The office keeps saying no coverage for that particular surgery.  They finally called today to say they are putting my case on hold.  She asked me to call back in January 2011.  They have to wait until Medicare pays them for a previous VSG.  I am not sure I really care right now.  I have written Florida Senator Bill Nelson.  The contradiction is too glaring for me to sit back and do nothing.  Anyway, no reason to post again unless I hear something different from the insurance coordinator.  Update in Jan 2011. 

My insurance coordinator called today and said my records are all set to be sent over to the nurses.  Now I am just waiting to hear from the nurses on any required testing.  One step closer to getting a date.  Shouldn't be long now.  One thing I can't do yet is the psychological evaluation.  I won't have the $500 until the first week in October.  I don't want to have the surgery during the holidays, so I am looking at having it done in January.  Plenty of time to do what is required and continue to contemplate on what this surgery means to me.  My next post might be a date. We'll see!

On Wednesday I went to my primary care physician to get a pre operation clearance.  He gave it to me without any hesitation and said I would do just fine.  In a bit of irony,  when I walked up to the front desk to sign in a woman was there giving the office staff some program materials from an area bariatric surgery program (not mine).  I talked to her for a bit and she invited me to join their support group since I live a lot closer to it.  Anyway, I will wait for my surgeon to call with any other required tests to have.  I know they will probably want an EGD done, which is no problem. I am waiting very patiently for my date.  Should have it by the end of this month.

So for those who might be following my situation, the insurance coordinator from the surgeon's office called me about one hour ago.  I have Medicare and pursuing sleeve gastrectomy surgery. Common Knowledge has been that original Medicare does not cover VSG.  Even my surgeon's office said they do not cover it.  But I have called Medicare 4 times in the last week.  Each time the representatives have told me that VSG CPT 43775 was covered. So I decided to start complaining to my doctor's office, and they finally were willing to admit that they believe Medicare WILL cover my surgery.  In fact, I may be one of their first.  While nothing is ever 100% guaranteed in the insurance world, it gives me hope for a better future.  All I have to do now is get a pre-op surgery release and medical necessity letter from my PCP. 

So I went  to an information session.  I have decided that the lap band procedure is not the surgery for me.  Had a change of mind and switched to being interested in the vertical sleeve gastrectomy or duodenal switch.  So I am waiting on the insurance coordinator to let me know if Medicare will approve my surgery.  In the meantime I will attend weight loss surgery support groups at Celebration Health and Florida Hospital Altamonte. Update by September 1st. 

I am new to this website and need all the help I can get.  I started considering the idea of lap band surgery just recently. It seems very scary.  I mean who in the world wants to be prone to vomiting at any moment or to having food get stuck.  Just don't know if I am ready for that.