janagirl33

Medicare advantage plans will pay for the sleeve depending on the contractor such as Trailblazers or National Gov. The jerks Noridian and Palmetto GBA will not pay. These darn intermediary companies (middle man) for medicare makes their own medicare guidelines per the state they represent.. It is such a Joke.. GHI medicare is not in my state so I am "f&*()kd.... scheduled for RNY but just don't know if this is the one for me. Much more invasive laparoscopic surgery.. Oh Well.. Im sick and I need to get healthy but not sicker by choosing the wrong WLS.... Tell me if you know anything different

The ASMSB is not entirely true.. Floridians who have medicare advantage plans (by medicare guidelines) have had the sleeve covered. Now if I am not mistaken Medicare is a federally funded insurance company added to a private insurance company, right? Equal right???. It appears truly unfair for some states to cover but others to be discriminately left out. If you look in the CMS website you and see which states are covered and which states are not.. WTF ?????

I was denied by Anthem BCBS for the Sleeve.. However when the offered the RNY I had a few concerns such as the stomach that they leave inside the body cannot be checked for anything such as cancer, lesions or strictures and was told that was right. I would hope that wouldn't happen to anyone but it is possible. To check this left over stomach would have to be through exploratory surgery.. No Way.. That made me too nervous to want to continue with the RNY. With the sleeve the stomach removed is actually removed from the body. gone with the Gherlin.

You know you are right about changing back to Medicare,, I was told by one of the Insurance Coordinators that Medicare would eliminate the lengthy pre approval and since I got the amount that would be paid for the sleeve from the Medicare rep, "go back to medicare". It would cover the sleeve as it is no longer investigational... I will further investigate this before March 31, 2010 when I can change back... If anyone else has information please let us know. Anthem BCBS as I said before denied my request for VSG with two different reasons.. 1) medicare did not cover then someone else said due to "not medically necessary" although BMI is 46.5, HBP, pre diabetic and meds taken that would cause problems with RNY. Immediate family history of stroke, diabetes, heart conditions all due to obesity.. I will appeal or go back to medicare if I can get more information.:scared0:

You know I really feel that the paperwork presented to BCBS was my problem. Instead of personally composing the letter to the insurance co they sent the form letter which left out my abdominal surgeries with scar tissue, meds needed to take such as NSaids that cant be taken with RNY.. The proof is in the pudding.. Insurance coordinators must give patients individual consideration.. I am going to appeal... thanx guys

Hi its me again... Now I am being told that Medicare advantage plans decide according to Medicare guidelines right???? Wrong.. It depends on who is the administrator or contractor for your Medicare Advantage plan. I wish I had known this prior to choosing BCBS. I want the VSG not the RNY.. I can change to another plan by 31st of March, but which one?.. Did you advantage plan tell you that the sleeve was a covered benefit. Mine did but they still denied it. I never was told about investigational and my BMI is 46.5, HBP, pre diabetic with chronic family history of stroke, heart conditions due to obesity. I was having the surgery done on an outpatient basis but was discuraged from that because I would have been stuck with the entire bill. Thanks for your info .. It gives me hope to appeal this cause I think the VSG can be approved. Medicare reps actually gave me the cpt code 43775 sleeve gastrectomy and how much medicare will pay. So what is the non coverage crap?...:scared0:

Hi Carolyn; I am a private business owner who hires U.S. citizens. I in no way said that it was all companies. I distinctly stated "wealthy" and if you fit in that category which I doubt. you have missed my point. Look, we are all in this together like it or not. I have a few "wealthy fat cat" associates who openly discuss illegal immigration saving them millions and will continue to push down any "terms" of returning illegals back to their countries. Gee what more did I need to say.... I couldn't care less what they do with the illegals as long as health care is provided for all U.S. citizens. Take for instance obesity type surgeries that you and I am having at a huge expense because the insurance "fat cats" wont cover.. Good luck and may you never have to find yourself or your family liquidating everything due to medical expenses,,,, Lastly.... I don't drink koolaid.....Have a good day...

Coopersmama, congrats on the weight loss. Don't worry you will get the house. Red tape is one of those things we have to go through practically everyday. You will get through this.. By the way I love ya dog and you look great.. i Can't wait until my surgery date.. Anyway keep the faith sistah as I will be praying for ya all the way from Las Vegas, NV....

Sorry people. But the wealthy in this country will continue to get "fat" on the backs of the middle class and some of the working poor. They have gotten away with paying little to no taxes, huge unjustified salaries and economic loopholes at every corner. Secondly;,get rid of Illigal Immigration ?? Are we kidding??? The tax evading wealthy work diligently behind the scenes to keep illegal immigrants here as it provides low paid workers as their nannies, maids etc., and although unemployment is at a record high, they still employ many illegals at their companies. This is much more important than being taxed adequately for universal health care for all U.S. citizens.