Greg_P

I've completed all Medicare requirements for VSG and will go on my surgeons list for October (I'll get my firm date end of August)! My surgeon says I have a slam dunk claim, and there is no logical reason I would be denied coverage. In my Medicare Administrative Contractors region of G (MN, WI, IL), the hospitial sumbits the claim "after" the surgery is complete. My hostpital feels comfortable with their chances at a successful Medicare claim so VSG here I come! Seems backwards, and potentially risky for both the hostpital and patient but thats the way it works here. I'm crossing my fingers and hoping the decision making (MAC) approves my VSG claim without making it difficult on me and the hostpital! Check out this link for more indepth information about how making claims with Medicare for the VSG works.... http://asmbs.org/201...ve-gastrectomy/

As newme0617 pointed out, this coverage decision is so new that it has not yet made it's way into the system Medicare phone reps work out of. Don't bother calling them, instead contact your hospital's Bariatric Coordinator. Additionally, coverage for VSG will be determined "case by case" at a local level. So VSG is covered, but not for everyone at a national level like the RNY or Lapband is. I Spoke directly with my Bariatric Director this afternoon about Medicare's VSG decision. She reviewed the CMS memo decision and agreed with my interpretation that this decision was a good one and coverage appears imminent. While the "fine" details for Medicare contractors (ie hospitals) have not yet been released (billing code, guidelines for submitting, etc) she did say everything looks like a go and I will be the first patient she submits for Medicare approval next month! For those of you who have not yet had the opportunity to get a personalized nod of approval from your hospital, read this and you should feel better. This is a summarized analysis and decoding of CMS's VSG memo from The American Society for Metabolic and Bariatric Surgery (ASMBS). A true authority in all matters concerning Bariatric's. http://asmbs.org/2012/06/access-to-care-alert-the-cms-final-decision/ At long last the wait is over! If you have state (MA) Medical Assistance (Medicade) this is good news for you as well. With very few exceptions, coverage and requirements for Medicade mirror that of Medicare. I suspect that state MA will recognize the VSG no later than October when coverages for all states go through their annual update. If you have not already begun taking the necessary steps to complete the requirements to be submitted for Insurance approval, NOW is the time to get started!

If you get a denial letter make sure you file a prompt appeal. Typically with most insurance compaines it's anywhere from 10-30 days window they will accept a appeal plea. Dont give up, fight them! Ask you doctor if he/she would be willing to write and sign a letter advocating their support of the VSG for you. I think you have a very soild case (if presented correctly) to win on a appeal.