Medicare approve Sleeve???

[wasup254]

A year ago....How did your surgeon get it approved?
Could you not have a lap band for some reason?
I had a lap band done and 2 months later removed (never even having a fill) due to an infection...

Thanks

[danrhowell]

I know that Louisiana has only a few places that will accept Medicare as the provider for the sleeve. I fought with People's Health and also Surgery Specialists of Louisiana for about 3 months now. I have had my PCP contact the insurance and also the surgeon and finally made an appt for 8-10-12 for my first visit. But Surgeon said they would not make an appt till I had clearance from Peoples, and Peoples said they couldnt give me clearance till I saw surgeon. Lots of Round and Round. I know that it has to be Medically Necessary or they will not approve it. I have also found out that it is up to the individual health providers whether they approve it or not. Wish me good luck.

[wasup254]

I see a doc here in Florida 8-15...hope to find out more info..I plan to bring the Medicare ruling with me, just in case they are unaware...if they are good at their jobs they are aware and can give me the ways to get this paid for by Medicare.

[gokiwi68]

ya know I have been fighting for my sleeve since 2008.....I medically need it as once all the weight is off I have to have a huge surgery....its a hell of a fight but keep on it....I am now having my sleeve 9th of august.....yyyyeeeaaaahhhhhaaaaaaaaaaaaaaaa

[wasup254]

I am now starting to understand that in order to have Medicare approve the sleeve, it is done on a local level, not a national broad based level......now that I understand, here is the next question.

If you want to use a doctor out of state that you live in, what "local" level of approval do I need? The state i am having surgery in or the state I live in...for example

I live in Florida
Surgeon is in Nevada

I am on Medicare

Thanks

[gokiwi68]

I would say Nevada because they are the ones that get the money....u need to have things wrong...Diabetes, sleepaneapa, depression, high cholesterol, high blood pressure....those are the things that will go away after the surgery and will make the quality of life good for u...oh and BMI over 35...how old r u and how tall, and what do u weight.......?????
why r u having it in Nevada...I believe Florida does it...

[wasup254]

I had a lap band on 4-18 in Nevada...had to have it removed 6-16 due to infection...I can have it reinserted in 3 months...but i want to do the sleeve, and have been reading that it is approved on a local level...

I am 56, 5' 3...200 right now, lost some weight from April surgery. I am at 35.2 BMI...I have osteoarthritis and GERD that qualified me before. i have gained 4 pounds in a month...

so you are saying it would be if Nevada Medicare is allowing gastric sleeve to be paid for by Medicare?

Thanks

[gokiwi68]

yes that it.....i am 64 5'4 bmi 39 weight 210