scsleever

I'll be going to Tijuana alone and am wondering what to do with my wallet, tablet, id, etc. while I'm in surgery, recovery, and wandering the halls at the hospital.

I think that most bariatric surgeons' offices are very knowledgeable about the requirements of the different insurance plans. It doesn't make sense for them to spend alot of time with you if your insurance won't approve the surgery..because that is where they make the big bucks! One word of caution: the requirements and coverage for the surgery could change once a year, after open enrollment, at the beginning of the "benefit year". Normally the coverage doesn't change, but if a plan is trying to keep premium costs down they could tighten up the requirements for elective surgeries.

Armywife29, Thanks so much for this great information! Questions: did you take any special care of your incision and drain sites while in the hospital? I've read that they make you shower each day, and I'm wondering about keeping the incision and drain areas bacteria-free. Also, how did you cover up the drain site to keep it waterproof while you showered? I'm picturing your abdomen with a saran wrap shield!!

It's been awhile since we heard from you, akwitham72. You've been through some tough times, and I'm a bit worried about you. Please post and let us know how you are doing. Sending good thoughts your way..... scsleever

Thanks, Beth. Your post really helps to put my mind at ease. I'm scheduled with Dr. Garcia on February 21st. I'll be on my own, so it's good to hear that you were well cared for.

Amy, I'll be going to Mexico for surgery next month, but only after I did everything (6 month supervised diet, fitness, nutrition, psych eval) and hoped, hoped, hoped that my insurance would approve the sleeve by the time I had finished it all. Well, I'm at the end of the 6 months and insurance still won't approve the sleeve for me, so I'm taking the financial and emotional leap to Mexico. But the six months have not been wasted: I've learned a great deal along the way. Also, the six months went by faster than I thought they would!! I always enjoy your posts, Amy... please stay with us on the Mexico forum as you move forward in your journey.

amytug, The surgical follow-up from the bariatric surgery group here is at two weeks, three months, six months and one year. I plan to go to my primary care at those intervals, and possibly get referred to a gastroenterologist if I'm having problems. I'm guessing that the two-week appt. is mainly a surgical incision healing check, as well as being sure that the patient is getting enough fluids and protein. For the 3-6-12 month appts, I'm hoping to use the forums to find out what bloodwork is typically ordered at those intervals. But...If it's a surgery complication, I'm heading right to the ER because I won't want to wait to get an appointment at a gastro or surgeon's office! BTW, I think we are going to be in Tijuana around the same time! I'm scheduled with Dr. Fernando Garcia on Feb. 21st

avonangel23, If you have normal Medicare, they will only pay 80%...many people carry a supplemental insurance plan to cover the remaining 20%. However, if you have a Medicare Advantage plan, the rules are very different. Your best bet is to find your health plan documents and read them.

Armywife29, Thanks so much for doing this!! I'm hoping for a February sleeve, and this really helps me. SCSleever

If you've been approved for VSG by Medicare (or have been told by your surgeon's office that you should be approved), please post and tell us which state you live in. Also, if you know, does your state have an upper age limit for VSG? Thanks so much...many of us trying to figure out the Medicare rules and regs, which vary by state.

I share your frustration, debiosbo! I have searched the web trying to find "the requirements" for the sleeve in the different states/regional contractors. It feels like an "information blackout". There's a lot written about the federal Medicare requirements for the sleeve, but the regional contractors' ADDITIONAL requirements don't seem to be documented. I still don't understand how we can all have the same insurance, pay the same amount, and then have our benefits rationed by a regional contractor. A favorite word of politicians is "transparency". Medicare is exactly the opposite: a black hole. They won't even tell us whether or not they will cover our surgery until AFTER the surgery has happened.

Please note that RNY surgery is covered in ALL states for ALL Medicare patients, regardless of age. They are handling surgery for the sleeve in a different way: Medicare decided to allow the Regional Contractors make the "final decision" on coverage for the Sleeve. I don't understand how a federal program (Medicare) can have different rules for coverage, depending on where you happen to live. Here's the deal: 26 states have sleeve gastrectomy coverage for all Medicare patients 7 states have limited sleeve gastrectomy coverage for age 64 years and younger; age 65 and older is excluded 11 states have limited sleeve gastrectomy coverage for ages 60 and younger; age 61 and older is excluded 6 states and Washington DC currently have NO sleeve gastrectomy coverage If anyone lives in one of the 26 states that cover the sleeve for all Medicare patients (no age discrimination), please let us know! And thank your lucky stars that you live in a state where Medicare will cover this surgery. I don't understand how a federal program (Medicare) can be administered this way- with different rules in different states. Any lawyers out there???

I finally found something online that gives a summary of Medicare coverage for the sleeve. The actual link is http://asmbs.org/2013/01/access-update-january-2013/...but the main info is: Here is a brief status report on the current landscape of sleeve gastrectomy coverage throughout the country: 26 states have sleeve gastrectomy coverage for all Medicare patients 7 states have limited sleeve gastrectomy coverage for age 64 years and younger; age 65 and older is excluded 11 states have limited sleeve gastrectomy coverage for ages 60 and younger; age 61 and older is excluded 6 states and Washington DC currently have no sleeve gastrectomy coverage If anyone lives in one of the 26 states that cover the sleeve for all Medicare patients, please let us know!

The Medicare requirements for approval of the sleeve are not the same in every state. When Medicare "approved" the sleeve, they left the final decision to the Regional Administrators (there are different regions for Medicare processing). So the Administrator gets to add more requirements! In South Carolina, where I live, Palmetto GBA (the Administrator) added an age requirement: you must be younger than 65 years of age. Hmmm... since most Medicare patients are 65 or older, this is an interesting requirement. Right now, Palmetto is "reviewing" their requirements for the sleeve, so I am hoping that they will remove that age requirement. .

It's my understanding that right now the decisions are being made by the Regional Medicare processors, and that some regions are approving it, others are not, and some have put in additional criteria (ex., must be younger than 61 years old). In my region, there is an age limit which means that I cannot get approved for the Sleeve...but they will pay for the RNY (no age criteria for that surgery). I am hoping that the Medicare policy on the Sleeve will be changed for 2013. If anyone knows how we can "lobby" Medicare for this change, please tell us how we can help.

Since I'll be going to Mexico on my own, I'm thinking that the hospital may be almost as important as the surgeon! It would be really helpful if some of you who have had surgery in Mexico would share your thoughts about the equipment and staffing at the hospital where you had your surgery. How was your IV solution monitored - was it an electronic machine that beeped or did you have to keep an eye on it yourself? How often did they take your vitals? How often did you see a nurse? Was the language barrier a problem for you? In pre-op, did a nurse or the anesthesiologist insert the IV line, and how did it go? In recovery, what was the level of care? And, in general, how was your hospital experience different from what you expected? Thanks so much for sharing your experiences!