I have been lurking in LapBand and Sleeve Talk for awhile and today I went to a weight loss seminar. I had decided the sleeve procedure was best for me but found out that Medicare insurance will not pay for the sleeve and is now requiring a 6 month supervised diet for the other procedures. My options are self-pay here, self-pay Mex., 6 months diet and hope Medicare starts paying for sleeve, 6 months diet and have gastric bypass or lapband, or forget it.

1. If I have complications here or in Mex.Medicare would not pay and if they were bad enough (a stroke, etc) it could cost hundreds of thousands of dollars.

2. Self pay here is $20,000. Mexico would mean no one to do follow up. I could afford either one, but not hundreds of thousands of dollars if necessary.

3. Medicare could take years to decide to pay for sleeve so diet would not count.

4. If I lose more than 20lbs on 6 months diet I will have a BMI less than 40 and might not qualify for band or bypass. My health problems are not severe (joints, back pain, arthritis,high choesterol, bladder leakage), but I am a senior citizen and I am in a hurry. 40 years of off and on dieting is ENOUGH

5. I don't think band would work for me and gastric bypass scares me.

What would you do?:cool0:

I have medicare a & b, but i don't have a medicare advantage program. I have a ppo through my employment as a Los Angeles county employee that covers my share of the part b expenses and i can use it in any state with any hospital or dr. that accepts medicare.

according to my ppo if medicare pays they will pay there share of the cost.

i have been cleared medically so i've decided to not have the gastric bypass and explore all other avenues along with staying on the diet.

i appreciate all of the comments from those who also have to jump through medicare hoops. i really think the sleeve is the best for me, i have had 2 open abdominal surgerys and my gallbladder was removed laproscopically so there has to be a lot of adhesions.

good luck to us all

marilyn:001_cool:

It really ticks me off that insurance companies are not covering this procedure. They want a compelling reason why their "covered" procedures aren't an option for you? How's this for compelling: Gastric Bypass: I don't want to have my insides rerouted and I'd like to continue to absorb all the nutrients I get from the little bit of food I do eat. For Lapband: I don't want to have a foriegn piece of plastic in my body that has a great chance of erroding into my stomach. Also, I'm not fond of having a permenant "keyhole" for fills.

I was sleeved 4 days ago, self pay here in TN by a "Center of Excellence" doc for 12k all inclusive. My insurance approved me for Lapband or GBP. I would pay out of pocket anyday than go with their policy!

He kept saying I was in excellent health, but he did suggest diet pills. I started them today and we shall see if they will work without side affects. People that have taken them say you don't feel hungry and that is what appealed to me about the sleeve.

Seriously???? Seriously your doctor suggested diet pills rather than a very easy surgery that will give you a permanent solution???? Holy cow.....some doctors have NO shame. Did you ask him how many people lost 100 pounds with diet pills and kept it off?

I'm sorry......if I had a doctor who's best suggestion was diet pills, I'd be looking for another doctor. I mean, that's got to be the absolute LEAST effective way to reduce weight safely.

Best of luck on getting some medically sound advice,

Thanks to all of you for your input. I am trying to just chill about this and let what happens happen.

The way the doctor put it was "You'll have most of your stomach cut away and it is a very serious procedure." I am trying the South Beach diet and the pills. I don't know how long I can do it, but I am trying. I go back in two months and we will see. Most of his patients have diabetis or/and hypertension. He actually seemed shocked to see a 71 year old with no real problems and although he was very nice I have been thinking to him I must have seemed naive and cluelessl. People come from all over to see him, but I guess they are mostly high risk. I thought diet pills were a no no, but so far I am not having any problems. In two months I will reevaluate the situation. Who knows, maybe insurance will have changed their mind!LOL

Trying to get straight answers while trying to speed through the medicare maze is impossible. Friday i talked to one of my clients who is a physician and his wife supervises the billing department about my denial. They told me the same as others of this site that approval of the VBG is determined by how well the dr. words the request. They told me to contact Palmetto which I tried to do but was unable to secure any other customer service # other than the regular medicare #. I was lucky to talk to an telephone operator who gave me even more information to confuse me.

Before she filled out the request to have someone call me I asked about after care if I decide to Self Pay. She said that under original medicare if I pay for something that it not covered under part B, that Part A would still pay for hospital costs. That's almost too good to be true so I would need to see that in writing or contact hospital billing.

I'm still not convinced that I'm ineligible for this procedure because I've had 2 open abdominal surgerys and one lap. Plus i have diverticula.

right now, i'm trying to stay calm so I don't over eat and gain back any that i've lost.

Good luck to us all trying to jump through the medicare hoops.

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

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:

Big News. I am at the end of my journey. Had a little hiccup with the stress test and now find out that Medicare has stopped approving it 2 weeks ago. They said they are still investigating. I am so freaked out, I want to crawl in the rabbit hole! Carol