MEDICARE any thing new

[debiosbo 36]

Anyone hear if Medicare has made any change to pay for the gastric sleeve I'm in Washington and having my surgery in Oregon .....

[HELLO ITS ME CAMI 27]

I had my surgery on 12-12-12 and I have Medicare. They approved according to my Dr. Good Luck!

[scorpio87 2]

I had my surgery on 12-12-12 and I have Medicare. They approved according to my Dr. Good Luck!

What was medicares requirments?

[HELLO ITS ME CAMI 27]

BMI 40plus other conditions. I have arthritis and High Blood pressure.

[.......... 129]

Me, 12/11, they aproved in CT. in October, medicare left it up to regional descresion but had aproved the sleeve in June.

http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=258&fromdb=true

[scsleever 104]

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.

.

[carstanger 346]

I live in Mi and had to pay for my sleeve because I am 65 (66) on Sat. Sleeved on Nov 12th. Had gall bladder removed as well as hiatal hernia repaired. Because of that they paid more on the hospital bill so am checking on it.

[scsleever 104]

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!

[carstanger 346]

Glad I didn't wait as I had mine done in November, and Medicare didn't cover it and since I turn 66 tomorrow, I know they still are not covering it in Michigan, according to the chart.....if I read it correctly.

[debiosbo 36]

I have Medicare and can't find out if my district Oregon and Washington are now going to cover the sleeve I have my last appointment on January 11, 2013 and am going crazy trying to find out I looked at the web site and still didn't understand I'm 55 years old and meet all the requirements PLEASE HELP ,now getting depressed

[scsleever 104]

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.

[debiosbo 36]

Do you know if Oregon and Washington district is one of the 11 states not approved for the sleeve yet I meet all requirements

[MIgroovy 1]

I found out about a month ago that Medicare is finally paying for my Sleeve about a month ago. I was supposed to be notified from the surgery clinic but had to find out on my own. I waited 2 years since I started this long trek. I have had my pre-op blood work, Stress Test by Cardiology, Chest X-ray, and EGD by my surgeon today to check the condition of my stomach and esophagus. All was well. I told my surgeon before the procedure today that the girl in charge of his clinic told me that I had to wait to have my surgery til after my third Mammogram in July. Surgeon said that it has nothing to do with the sleeve so he will talk to her today when he got back to the office. I hope it's soon. I've already seen the nutritionist, my psych test should be good for 2 years so waiting for an Auth. From Medicare so I can get my surgery date. Then, all I have left is the two week pre-op diet.

[MIgroovy 1]

You probably gathered from my screen name. I live in northwestern Michigan. The guideline for me was that I had to have a BMI of at least 35 with minimum of 2 co-morbidities. I have sleep apnea, osteo-arthritis (fusion/laminectomy of lower spine and neck), Total Knee Replacement, tendon transplants; Hypertension; High Cholesterol; Major Depressive Disorder. I have many other health problems and past surgeries but the ones I listed matters to qualify for the Sleeve.

[marfar7 1,528]

Do you know if Oregon and Washington district is one of the 11 states not approved for the sleeve yet I meet all requirements

I live in Oregon. I was told by my drs office insurance coordinator on Monday that Medicare DOES cover the sleeve. They'll cover mine (even tho my bmi is only 28) because of a complication with my band (slip).

However, last year I cancelled my part b coverage (I'm a disabled vet and use the VA for all medical stuff - cept my wls-and felt $110 a month was being wasted on drs office coverage when I never used it). Now I'm kicking myself. Part A doesn't cover the drs charges (about $5,000). I called Medicare and they said I can't add it back in till Jan and then it won't take effect till next July! Now I'm stuck with a slipped band and having to pay at least $2500 (my dr said he could do it for about 1/2) to have my revision.

Live and learn...

So, yes, Oregon does cover the sleeve. I think the requirements are:

1. >40 BMI or >35 with at least 1 comorbidity

2. <65 yrs old

They don't have the same requirements for dieting or the 6 mth waiting period that other insurances do. When I got my band almost 4 yrs ago, I went in for my 1st appt on Aug 30th, had my nutrition and psych eval on Sep 15th and went in for surgery on oct 1. No hoops at all to jump thru.

Where r u having your surgery? Dr Steven Tersigni in Coos Bay does me. I hafta drive 3 hrs to se him. But Medicare only covers Centers of Excellence.

Good luck!