Hi! This is my first post and it's been a VERY bad day for me. My insurance company told me today that they do not cover ANY bariatric surgery. I was mortified. My doctor has been talking to me for the last six months about needing to do the sleeve procedure. I cannot do lap band for health reasons nor regular gastric bypass [although for health reasons]. I'm on disability and my husband is a teacher. We are on a VERY limited income. Has anyone had ANY success with an insurance appeal? I have to write a letter the insurance company this weekend but don't know what details I should put into it. Any advice would be greatly appreciated.

Thank you in advance.

Blessings~

I'm not on any kind of Advantage plan however. Is that the difference? I'm just on basic Medicare Disability Coverage when I was permanently disqualified from working a few years ago. My husband's insurance doesn't cover this procedure. Do you have an Advantage plan?

I'm not on any kind of Advantage plan however. Is that the difference? I'm just on basic Medicare Disability Coverage when I was permanently disqualified from working a few years ago. My husband's insurance doesn't cover this procedure. Do you have an Advantage plan?

Doesn't matter! I switched to an advantage plan when I knew I was having this surgery. I am single and couldn't come up with 20%. Medicare covers whatvit covers! http://www.obesitycoverage.com/component/zoo/item/medicare-requirements-for-weight-loss-surgery

Medicare is supposed to start covering the sleeve in all states, but when is everyone's question. You may have to wait until it's approved in your state, but it shouldn't be long.

Your other option is Mexico. You can go to very skilled surgeons in MX for much less. If you choose that route, you'll need to do some research on surgeons.

Oregondaisy, I see your surgery was in 2009. How are you doing. What do your meals consist of at this point? Someone told me after a year or so, you could actually eat a small version of a meal: protein, small amt veggie, small amt of say brown rice. Is this true?

When did they tell you that? Medicare approved VSG in July 2012. Arkansas' date=' which is in a larger region didn't approve it until Jan, but mine was ready to go as soon as it was approved and I get sleeved Monday! Check again. I can't have the others either....its an nsaid thing....its very common for many to only be able to have this surgery. But Medicare DOES cover this surgery.[/quote']

How do I find out if it covers in Ohio?

Oregondaisy, I see your surgery was in 2009. How are you doing. What do your meals consist of at this point? Someone told me after a year or so, you could actually eat a small version of a meal: protein, small amt veggie, small amt of say brown rice. Is this true?

Yes this is true. I eat very normally. I eat anything I want. I just eat smaller portions. If I want to eat veggies, I usually will eat them first, because meat fills me up so fast. I try not to eat starches because they make me gain weight. I can eat anything just fine though.

That's wonderful! I have what may seem like a silly question but I can't figure it out. How do you get the widget on your profile that shows your starting-goal weight and now much you've lost?

Thanks and Blessings~

That's wonderful! I have what may seem like a silly question but I can't figure it out. How do you get the widget on your profile that shows your starting-goal weight and now much you've lost?

Thanks and Blessings~

It's in your profile under "tickers"

It's in your profile under "tickers"

Only on your computer....not the app!

Doesn't matter! I switched to an advantage plan when I knew I was having this surgery. I am single and couldn't come up with 20%. Medicare covers whatvit covers! http://www.obesitycoverage.com/component/zoo/item/medicare-requirements-for-weight-loss-surgery

How do you get Medicare? I have the 20% on my insurance coverage too. I'm stressed about the money, how did you got about this?

How do you get Medicare? I have the 20% on my insurance coverage too. I'm stressed about the money' date=' how did you got about this?[/quote']

Do you mean an advantage plan? If you are already on Medicare during the enrollment plan in October November ish you can switch to an Advantage plan if they're offering your area your county or state. My surgery cost $200 to get started last April, $20 per visit for 6 months and then a $35 copay for the surgeon. I also have a $200 copay to hospital in the morning. I went to my seminar in Oct of 2011 and found a freindly advantage plan. For me it's been bcbs. Then after the first of the year 2012 I signed up. I was only approved for the sleeve per my rheumy and Medicare didn't approve sleeve in my state until Jan 2013. ....so tomorrow is the day! Hope that answered some questions

My suggestion would be to talk to the utilization review nurse at your insurance company that is the person who approves or denies your coverage for a procedure that needs medical review to be covered. Be up front and honest and ask why they denied your surgery. More importantly ask them what they need to make the exception. Try not to get emotional or angry it won't get you anywhere and that will be the hardest part. I have heard for several people (and know of two personally) who have gotten coverage by appealling the original decision. Do not give up. Information is power not go get the info you need.

i'm on disabilty and on medicare. my dr got me approved for VSG .. there was some out of pocket cost but my dr really went to bat for me, dont give up.. hope it all works out for you.. i'm praying for your approval..

My insurance excludes WLS as does my DH's. I'm doing the self pay route in Mexico.

Amanda Rae

I have bcbs right now. My out of pocket is 5k which isn't something I could come up with right away. How do you get on Medicare?