Outraged! Age Discrimination in Medicare coverage of the Sleeve!

[scsleever 104]

Please note that RNY surgery is covered in ALL states for ALL Medicare patients, regardless of age. They are handling surgery for the sleeve in a different way:

Medicare decided to allow the Regional Contractors make the "final decision" on coverage for the Sleeve. I don't understand how a federal program (Medicare) can have different rules for coverage, depending on where you happen to live.

Here's the deal:

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 (no age discrimination), please let us know! And thank your lucky stars that you live in a state where Medicare will cover this surgery.

I don't understand how a federal program (Medicare) can be administered this way- with different rules in different states. Any lawyers out there???

[kmwheel 127]

I think that's baloney, but I was afraid that was what was going to happen when they left it up to the regional contractors. My dad was asking if he'd be approved for the sleeve (he's 73), and I told him that I doubted it. It makes no sense that RNY would be approved and not the sleeve, because VSG is (I think) far less invasive. I was waiting and waiting for Medicare/Medicaid to get around to it, because I have TriCare and they usually follow Medicare's lead. I'm glad I didn't wait any longer...I ended up going self-pay. In my dad's case, I just don't think it's ever going to happen for him, and that makes me so sad.

[GrannyGoes4it 10]

I live in Florida, do you know if I will be covered, I will call my doc as soon as they open, I am 65, will be 66 in June, all I had heard was after 65 there might be a problem. I am almost done with my medical clearances, going for pulmonary function test today, then blood work and appt with GP and I will be done and ready for surgery after my last class March 1st and pre op class March 4, this is upsetting. I sure hope Florida is covered.

[Mrs Havelock 154]

Statistics have shown that performing the sleeve on people over 65 has no effect on their longevity. That'll be why it's not covered.

[kyllfalcon 768]

There are lots of federal programs and laws that are enforced/enacted differently depending upon state/region. Makes no sense, but it is the case.

[GrannyGoes4it 10]

Hi, I checked with my Dr. office, in Florida, they have not had problems with approval. They said they would check it out but had not heard of any problems due to regions. So not sure? Where do you live that you were refused and what states are doing this?

[scsleever 104]

Grannygoes4it,

You are in luck...my research showed that Florida does NOT have an age limit for the surgery!

[scsleever 104]

Mrs Havlock,

It's hard to believe that mortality rates for morbidly obese people don't change when they lose 100+ pounds!

[LizInTexas 125]

Please note that RNY surgery is covered in ALL states for ALL Medicare patients, regardless of age. They are handling surgery for the sleeve in a different way:

Medicare decided to allow the Regional Contractors make the "final decision" on coverage for the Sleeve. I don't understand how a federal program (Medicare) can have different rules for coverage, depending on where you happen to live.

Here's the deal:

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 (no age discrimination), please let us know! And thank your lucky stars that you live in a state where Medicare will cover this surgery.

I don't understand how a federal program (Medicare) can be administered this way- with different rules in different states. Any lawyers out there???

Do you happen to have a link you can post to the source of this information ? I'd like to see more details, specifically, what states have which limitations and the qualification criteria. My options were self pay, or self pay, but it's been worth every single cent ! I'm trying to persuade my brother to consider VSG. He had his first 3 heart attacks at the age of 36, is now 52 and fully disabled because of the 8 stents in his heart, and is ringing the bell somewhere in the vicinity of 375 - 400 pounds, and getting heavier by the week. To say that I fear for his life is a major understatement.

[Mrs Havelock 154]

Mrs Havlock' date='

It's hard to believe that mortality rates for morbidly obese people don't change when they lose 100+ pounds![/quote']

I agree, it seems counter-intuitive. I'll find a link to the study for you when I get home

[carstanger 346]

I was 65 when I had mine done in Nov and Michigan would not cover the sleeve. Would have covered the gastric bypass but I wouldn't have that done. So.., I was self pay.

[jackpell 17]

I live in central Florida and I am 69 yo. Medicare just started paying for the sleeve in this area as on Jan 20013. They would have paid for both R n y and the band before but now covers the sleeve. I waited allmost 6 months for Medicare to pay. Well worth the wait.

[NurseGrace 509]

It's just because of statistical data.

[mommyradd 115]

Statistics have shown that performing the sleeve on people over 65 has no effect on their longevity. That'll be why it's not covered.

Whether or not this is true, it's still unfair, and what about quality of life??? I'm only 13 weeks out and already my life is better than it was before surgery. It's sad that people are being denied this tool because of their age.

[NurseGrace 509]

Whether or not this is true, it's still unfair, and what about quality of life??? I'm only 13 weeks out and already my life is better than it was before surgery. It's sad that people are being denied this tool because of their age.

Yeah, I won't say its right or wrong, I'm just saying thats the reason - they also do this with knee replacements and other operations after a certain age. at some point the cons don't outweigh the pros