Medicare and the sleeve

I am feeling very frustrated.  After working to qualify for WLS, I found out that Medicare would not cover the gastric sleeve.  I then went to the VA.  This morning I finally finished jumping through all of the VA hoops only to be told that the waiting list for WLS has gone from six months to about a year. To add insult to injury, I was told that Medicare is covering the sleeve in some parts of the country but not in Pennsylvania.   If anyone has been approved for the sleeve by Medicare, I would be interested in hearing where it is being covered.  I intend to contact my congressman about the inequality in care being provided.  Knowing what states are covering the sleeve would be a great help in making my case.

It's my understanding that it's not a matter of which state you live in, but who administers your Medicare coverage. Very unfair, I agree.

Have you considered the DS? It has the same stomach as the Sleeve, plus an intestinal bypass to provide metabolic change. It has the very best long-term, maintained weight-loss stats, period---and Medicare covers it EVERYWHERE. (*grin*)

Thanks for the suggestion.  Due to other medical problems, I'm not willing to risk malabsorption problems. I have been in contact with my congressman's office since I wrote the original post.  It is unfair and unethical to deny certain services to a beneficiary solely on the basis of geographic location.  I intend to push this issue as far as I can.  We all pay the same taxes, we should all receive the same coverage.  

Go to the following link. Medicare made the decision to cover the sleeve earlier this year. I sent this link to a friend and she gave it to her surgeon (in California) and she had her sleeve surgery 3 weeks later! Worth a try, I say.

Good luck!!!!!

http://www.cms.gov/medicare-coverage-database/details/nca-de cision-memo.aspx?NCAId=258&ver=2&NcaName=Bariatric+Surgery+f or+the+Treatment+of+Morbid+Obesity&MEDCACId=26&IsPopup=y&bc= AAAAAAAAIBAA&

It's no fair, but it has been approved for Ohio Best of luck

Thirty miles further west and I'd be OK.  

Hi,

I live in Connecticut and am having my sleeve surgery approved by Medicare on Wednesday (11/28).  I am having the surgery at Yale New Haven Hospital (Dr. Bell).  It may be a couple of hours driving for you, but Medicare is approving them here in Connecticut.  Hope that helps.

Kim

P.S. It's amazing what a well scripted letter to "all" the right people from Governors on up can accomplish. From personal experience don't stop with one letter.  cc: a few so each can see who else got the same letter and who acted on it (LOL) it works! Even if you don't end up being approved in your state right now, at least you are trying to make it easier for those who will follow in your steps.  Good Luck!

I wish you all the best with your surgery.  I'm left with no other option but to push ahead with my letter writing campaign.  I will post here if I manage to break through the bureaucratic blockade.  

Since you're going through the VA system, it might be a good option to see if you could do it in one of the other :approved" states - and perhaps find one with a slightly shorter waiting time (though I think it would be great of you to keep up your advocacy in your home state at the same time). Another (maybe remote) possibility would be if you had a surgeon who was willing to work with you on it (and that you trusted), try for approval for a DS but then when the surgeon does the surgery s/he could say there was some medical reason s/he saw that indicated s/he should not complete the second portion (the "switch"). This would likely not work in a VA hospital though since they tend to be more by the book, but if you also have Tricare, it might be something to think about, though again, maybe a long shot.