1St Denial - Medicare Anthem Bcbs

[Mickie Vest 29]

I got the call today that my pre-approval was denied because the sleeve isn't covered by medicare. Now I know some people out there have gotten the sleeve approved via medicare. I appealed it and the drs. office is resubmitting the forms for the gastric bypass.

Anyone on medicare run into this?

[havehope4all 1]

I have medicare and had the sleeve on 10/22. approved ist time, already seen bill and how much medicare paid. I did have to be under 61.

[FDclerical 318]

i think it depends on your state. my medicaid covered it. they should cover all 3 bariatric surgeries as long as you qualify.

[mokee 588]

I am scheduled for the sleeve in 2 weeks and medicare is my primary and I also have secondary. I live in the Cinti area like you. I was told that Medicare was paying as of 2 months ago for the sleeve.

[scsleever 104]

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.

[mokee 588]

So I guess I need some help, Anyone from the Cinti oh area that is over 61 have the sleeve recently and was it covered.. My BCBS will not give me a pre-cert because I have medicare. But if Medicare does not pay then they will not pay either and I will be stuck with the whole bill.

[Mickie Vest 29]

I'm 51 and should qualify for the surgery. I appealed with Anthem bcbs but I don't really want an RNY but I guess I'll take it if that is my only other option. Self pay isn't an option.

[MIgroovy 1]

I have medicare and had the sleeve on 10/22. approved ist time' date=' already seen bill and how much medicare paid. I did have to be under 61.[/quote']

Congratulations! May I ask what state you're in?

[Bebee 33]

i think it depends on your state. my medicaid covered it. they should cover all 3 bariatric surgeries as long as you qualify.

What 3 surgeries??

[Bebee 33]

Louisiana

[ebonisekim 1,713]

Louisiana

What part of Louisiana are u from ?

[Bebee 33]

Vacherie

[fallingwhisper 187]

What 3 surgeries??

The 3 surgeries are lap band, sleeve or bypass

[Bebee 33]

Im gettin da Sleeve...

[Bebee 33]

Im gettin da sleeve