I dont know if this has been discussed here yet, but I wanted to inform you all a Medicare medical review is nearly complete pertaining to official coverage of the VSG. If all goes well, we should have a peliminary decision at the end of this month (3/30/2012)! A final binding decision will be made no later than 6/28/2012.

Offical documentation can be found here....

https://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=258&fromdb=true

I spoke with my Bariatric Surgeons P.A. today and discussed the Medicare coverage review of the VSG. He told me based on his attendance at the annual Bariatric Surgeons convention he was told coverage for the VSG is very likley to be approved for Medicare. He did not want to cite names, but did say his information came from very reliable sources close to the review process. He went so far as to say (without prompting) "He would be shocked if the review panel rejected covering it this year".

Im starting my 6 month required supervised diet (ie Nutritionist) consultations now to be ready for submittal come October when Medicare updates it's coverage. Those of you on Medicare and Medicade who have been holding out for VSG surgery coverage I strongly suggest contacting your Hospitial's Bariatric cordinator and starting the nessicary legwork now. Starting now, I will have everything needed for insurance approval ready to go the moment coverage goes live.

~Greg

I just read this post... it should be good info for you and ginger if you decide to self pay...

http://www.verticalsleevetalk.com/topic/32644-800000-self-pay-in-the-us/

Thanks for the information reading Self Pay…looks like a great surgeon and a good deal. I'm really trying all my other options before I consider self pay.

I too was wondering if Medicare covers costs for sleeve surgery. I also have Aetna insurance as a supplemental. Does that matter?

I too was wondering if Medicare covers costs for sleeve surgery. I also have Aetna insurance as a supplemental. Does that matter?

Medicare doesn't cover as of now, but did you see if Aetna does?

Medicare doesn't cover as of now' date=' but did you see if Aetna does?[/quote']

I spoke with Vanessa at Medicare yesterday & she said that Medicare does pay for weight loss surgery providing one meets certain health criteria: has a high BMI, has tried diets before, has no psychological problems, has health issues such as diabetes, high blood pressure, etc.

She even assisted me with the names of hospitals/clinics in my Zip code area that perform the surgeries. I'm calling Aetna today (supplemental insurance coverage to Medicare) to inquire about their coverage.

Sdb,

Medicare does cover other weight loss surgeries, but not Vertical Sleeve Gastrectomy. That's the big daddy that everyone's waiting for.

she said that Medicare does pay for weight loss surgery

when i had my WLS,12/15/11 medicare did not accept the sleeve. so i luckily had a secondary ins. that did accept it fully.

i believe that the lapband & gastric bypass have been approved for quite a while.

i have heard from many on the board that the sleeve is not accepted yet - but they are in the process of continually looking at it, and hopefully will have a positive decision in a matter of months approving the sleeve

good luck to all w/medicare on the brain.

kathy

Just checked with Aetna Insurance (my supplemental medical insurance) and they said they cover weight loss surgery. Kind of ambiguous about whether or not the Gastric Sleeve is covered, but I've signed up for a couple of seminars so I'll ask the experts.

My primary care doctor said that she thought weight loss surgery would be an excellent step for me.

Ok, sdb originally asked if Medicare covered the "sleeve surgery". If by "sleeve surgery" you mean vertical sleeve gastrectomy, then no, Medicare does not cover it at this time. They do cover other WLSs. If you read this entire thread from the first post, then it will explain where Medicare is at in consideration of VSG.

Thanks @Anjelika for the feedback. I read a post earlier that said gastric sleeve was in the process of review & that as of the end of March (2012) it looked like they were going to finally approve it (by June-2012). Starting all my preparation & investigation now so hopefully Medicare will approve by the time I'm ready for surgery.

I hope they approve it as well! Good luck on your journey.

I hope they approve it as well! Good luck on your journey.

Me too! All this Medicare/Aetna insurance stuff is enough to drive one crazy. They speak in languages only they understand.

Me too! All this Medicare/Aetna insurance stuff is enough to drive one crazy. They speak in languages only they understand.

Majority of the times, I don't think my insurance reps even understand themselves. Lol

Majority of the times' date=' I don't think my insurance reps even understand themselves. Lol[/quote']

Attended another seminar for weight loss surgery last night. Was told up front that Medicare will NOT cover the sleeve procedure. They will however check with my supplemental coverage (Aetna) to see if they will. Oh, the forms to fill!

I am finding this thread really interesting since I had my sleeve on 4/3/12 that was paid for 100% by my Medicare and Medicaid. I live in Florida and had my surgery at Shands at University of Florida in Gainesville. My surgeon was Dr. Caban (partner with Dr. Ben-David.)