Coverage

 Hello. I have some questions. My insurance is Medicare and Medicaid. I know that the CMS is reviewing and making a final decision by the end of June about covering or not covering VSG, but also read the memo that suggests the sleeve will only be covered in research clinical trials. Very disappointing. BUT, I have to say how confused I am about something. I've read a couple examples of people that HAD their sleeve covered because they convinced CMS with the help of their doctor that they needed the sleeve instead of the other covered surgeries in order to continue taking necessary medications like NSAIDS which can not be taken with the covered surgeries. I feel like coverage CAN happen if you find the loop holes, but feel like doctors and office staff is against trying to help with this. LIke they are the speedbumps in the road. Might never get covered even if I do appeal and try this approach, but shouldnt we ATTEMPT to get it covered instead of assuming they will say NO and not bother with it? Has anyone had luck getting approval? If so, how did you? I want this so much but can not afford self pay because I dont think I could get enough credit or loans to self pay! I really want to find a way to get an approval. I went for Lapband, was literally sent home after getting the IV on the way to surgery because I had an unexplained fever. Probably the best thing that happened to me in hindsight. I read such horror stories of the band! I am SET on wanting VSG, so what can I do???????? Thank you

 One more thing, if you did get approval from an insurance company, who said YES? :)

I am so with you on this. I have read everything I can, researched the Medicare site, and talked to everyone I can think of. The way I understand it, as you said, there will be clinical trials and depending on the outcome of these trials, they will then make the decision of whether sleeve will be approved or not. I've called my potential surgeon's office and they said they have no knowledge of how to get into on the the trials.
To my knowledge, Medicare hasn't paid for sleeves, unless they are part of the 2 part surgery for extremely morbidly obese people who have to have the sleeve done first and then the intestines rerouted at a later date. I also seriously considered the lapband until I heard of the horror stories here. So unfortunately at this time, Medicare is not paying for sleeves. We will have to keep our fingers crossed.

read my blog page in the section "four and a half months out" for my appeal letter and how i won my appeal with blue cross nearly 3 years ago. nsaids was an issue for me. don't know how medicare appeals work.  diane

 thank you both. Seems like everyone with Medicare or Medicaid is getting a big fat NO, so I will read this appeal information and see if I can do anything with it. They seem to be very set in concrete once they deny a procedure. Not sure why they are so against it with these fantastic results. Wish this was easier. Thanks again.