I went to a seminar for weight loss surgery present by DR, Srikanth at the Center for Weight Loss Excellence. I was really impressed and took all the paperwork to have ti submitted to the insurance for approval. I currently have asuris NW, reform 3000. They denied me but i have not followed up on why. Doctors office only told me they would not cover it. Has anyone experience anything with Asuris?

I am curious why they would nto cover it. I am 23, 365Lbs, at 6'. I have a very physical job and have noticed my abilities decreasing rapidly. I have tried numerous diets with no success. THe cost of not doing anything about it is going to be a lot more than the surgery.

Medicare coverage for VSG is currently under review, folks!  We may finally see VSG covered by Medicare by the end of June, 2012!  That should cause other insurers to move as well.

 

CMS, the Centers for Medicare and Medicaid Services, which really “is" Medicare, announced on 09/30/2011 that it’s soliciting comments on a proposal to cover laparoscopic sleeve gastrectomy (VSG) for Medicare patients.  The Public Comment Period is from 9/30/2011 - 10/30/2011. The Proposed Decision Due Date is 03/30/2012 with a final decision by 6/28/2012.  The big question appears to be availability & sufficiency of long-term data.

 

You can see the CMS Solicitation for Comments and read submitted comments at https://www.cms.gov/medicare-coverage-database/details/nca-t racking-sheet.aspx?NCAId=258&fromdb=true .

 

Also, in addition to the CMS info, the Internal Medicine News Digital Network reported that “A recent observational study presented at the annual meeting of the American Surgical Association found that at 1 year after surgery, LSG was associated with morbidity and effectiveness rates that fell between those of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y bypass procedures.

The absolute reduction in BMI at 1 year was smallest in the laparoscopic adjustable gastric banding group at about 6, greatest with open or laparoscopic Roux-en-Y gastric bypass at about 15, and intermediate at close to 12 with LSG.

The study, based on prospective, longitudinal, standardized data from 109 hospitals, was the first to come out of the ACS Bariatric Surgery Center Network accreditation program. Additional years of follow-up are planned, according to Dr. Matthew M. Hutter, an ACS Fellow with Massachusetts General Hospital, Boston."  (Source: http://www.internalmedicinenews.com/news/gastroenterology/si ngle-article/cms-considers-coverage-of-laparoscopic-sleeve-g astrectomy/fc3fe54035.html )

Harv

Can someone provide me with the link to check online your tricare referral status...I had the link saved and then my computer crashed....

Thanks

Hi! I too was approved by Molina Healthcare in less than 2 weeks! I have been trying for years with different insurance companies to have my RNY done so I was in shock when I found out I was finally approved. Jean is awesome. My surgery date is Nov. 7. I hope you are doing well! If you have any advice or words of encouragement, I'd love to hear it. Take care.

Lori,

Have you heard anything back about your appeal?  Also, I would like to take a look at the information that you have.  Could you email it to me?

Thanks!

Brandy