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  1. #1
    Gastric Sleeve Member von buck's Avatar
    Name
    Andy
    Surgeon
    no idea
    Join Date
    Aug 2015
    Last Activity
    04-01-2016 10:24 AM
    Location
    originally New Haven Ct, now Stoneham MA
    Posts
    14
    Said "Thanks" 10 Times
    Was Thanked 1 Time in 1 Post
    Said "Welcome to Gastric Sleeve" 5 Times

    Default Who's gone through Medicare to get their surgery?

    I have my first consultation to begin my journey, but I'm having doubts about whether it's worth the wait with Medicare. I'm going to have to through a supervised diet to prove I can't lose weight the standard way psychological tests, etc.
    Is this standard with all insurance? It almost seems like their looking for a reason to deny.
    Maybe I'll just win powerball and I can just go get it done


  2. Gastric Sleeve Surgery With Weight Loss Agents
  3. #2
    Gastric Sleeve Member azladyrider's Avatar
    I have had a gastric sleeve.
    Name
    Sue Ashe
    Surgery date
    06/28/2012
    Surgeon
    Dr Almanza
    Join Date
    Apr 2012
    Location
    Apache Junction, AZ
    Posts
    998
    Said "Thanks" 42 Times
    Was Thanked 326 Times in 229 Posts
    Said "Welcome to Gastric Sleeve" 7 Times
    Blog Entries
    6

    Default Re: Who's gone through Medicare to get their surgery?

    I've never heard they want you to prove you can't lose weight - just the opposite - they usually (or so I thought) want you to prove that you can lose a certain amount of weight. My understanding is that they want to see if you can stick to some type of eating healthier and making the right choices since the sleeve is a tool and a jumping off point. After the initial weight loss it's mostly all on you. I didn't go through any testing (I would be afraid of any psychological testing since I know I'm nuts already) plus my BMI wasn't high enough for the state but it was for the mexico standards



  4. #3
    Gastric Sleeve Member Ann2's Avatar
    I have had a gastric sleeve.
    Name
    Ann2
    Surgery date
    08/18/2014
    Surgeon
    n.a.
    Join Date
    Oct 2013
    Location
    Missouri
    Posts
    6,630
    Said "Thanks" 5,839 Times
    Was Thanked 5,052 Times in 2,720 Posts
    Said "Welcome to Gastric Sleeve" 3,616 Times
    Blog Entries
    3

    Default Re: Who's gone through Medicare to get their surgery?

    I had VSG surgery in Missouri at age 68, so my Medicare and Medicare supplemental insurance funded my surgery.

    I had lost a significant amount of weight under my PCP's supervision about three years prior to surgery, but had regained all that weight and more back.

    My BMI was a hair under 40.0 when I started, and I had 3 comorbidities (arthritis, stress incontinence, and lower back pain -- and maybe one other -- I forget.) In any event, my recorded weight at my first consultation meeting with the surgeon was the one that mattered for insurance qualification purposes. I did lose about 20 pounds pre-op on my own diet and the surgeon's pre-op, liver-shrinking diet. But that weight loss didn't un-qualify me. And as insurance I tucked some half-pound weights into my bra and pockets and guzzled water like crazy before all my other pre-op weigh-ins. So sue me, Medicare!

    FYI, I live in Missouri. Although I still don't understand why (since Medicare is a federal 50-state insurance program -- we all pay Medicare insurance premiums), I've been told there are differences state to state with regard to WLS pre-op requirements. (Again, I'm talking Medicare, not Medicaid.) So I can't guarantee that Medicare in your state and for your situation is administered the same as here.

    The main thing to do is to become friends with your surgeon's patient ombudsman / insurance coordinator. Don't guess or make assumptions about any of this stuff based on my or others' experiences. Ask her/him. She/he knows FAR more about all this than I do and more than your surgeon knows.

    Good luck.



    Consult: 235 lbs
    My and doc's preop diet: 216 -19 lbs
    M1 postop 205 -30
    M2 193 -42
    M3 184 -51
    M4 174 -61
    M5 167 -68
    M6 162 -73
    M7 156 -79
    M8 151 -84
    M9 148 -87
    M10 146 -89
    M11 144 -91
    M12 143 -92
    M13 142 -93
    M14 140 -95
    M15 139 -96
    M16 137 -98
    M17 135 -100

    First Surgiversary post

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  5. #4
    Gastric Sleeve Member mtngrl's Avatar
    I have had a gastric sleeve.
    Surgery date
    06/08/2015
    Surgeon
    Dr, Chae
    Join Date
    Apr 2015
    Last Activity
    05-24-2016 05:28 PM
    Location
    Colorado
    Posts
    374
    Said "Thanks" 57 Times
    Was Thanked 135 Times in 120 Posts
    Said "Welcome to Gastric Sleeve" 984 Times

    Default Re: Who's gone through Medicare to get their surgery?

    In Colorado, Medicare won't pay for the gastric sleeve,. The bypass and band is what is covered in this state. I could have gone through another company that does the surgery in Nevada and Medicare would have paid for that. I just didn't want to travel after surgery. Although I had to pay for the surgery out of pocket, I have to say I was happy not to have to wait for 6 months of supervised weight loss with a dietitian.



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  7. #5
    Gastric Sleeve Member Damasyn's Avatar
    I have had a gastric sleeve.
    Surgery date
    11/04/2014
    Surgeon
    Dr Andrew Bright
    Join Date
    Oct 2014
    Last Activity
    12-29-2015 02:20 AM
    Location
    Washington State
    Posts
    229
    Said "Thanks" 57 Times
    Was Thanked 68 Times in 55 Posts
    Said "Welcome to Gastric Sleeve" 5 Times
    Blog Entries
    11

    Default Re: Who's gone through Medicare to get their surgery?

    i have medicare and got the surgery. I was approved and scheduled for surgery within 2 months
    Honk if you want to see my finger !!

  8. Gastric Sleeve Surgery With Weight Loss Agents
  9. #6
    Gastric Sleeve Member von buck's Avatar
    Name
    Andy
    Surgeon
    no idea
    Join Date
    Aug 2015
    Last Activity
    04-01-2016 10:24 AM
    Location
    originally New Haven Ct, now Stoneham MA
    Posts
    14
    Said "Thanks" 10 Times
    Was Thanked 1 Time in 1 Post
    Said "Welcome to Gastric Sleeve" 5 Times

    Default Re: Who's gone through Medicare to get their surgery?

    Thanks for your input everyone. I'll get my situation cleared up with I meet with the councilor Wednesday. Hopefully I'm just worried for nothing and reading too much into the Medicare list of rules. I have a prosthetic leg and sometimes I have to jump through hoops for upgrading. Luckily, my prosthetics is a great advocate and knows how to get things done. Hopefully whoever my advocate in the hospital will be as knowledgeable and dedicated as these guys are


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