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  1. #1
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Surgery date
    09/05/2012
    Surgeon
    Dr. Rosenthol
    Join Date
    Oct 2011
    Last Activity
    02-18-2014 08:43 AM
    Posts
    9
    Said "Thanks" 2 Times
    Was Thanked 0 Times in 0 Posts
    Said "Welcome to Gastric Sleeve" 6 Times

    Question Medicare approve Sleeve???

    I have been waiting for Medicare to approve the sleeve. My surgeon thought it was sure to be done by the end of 2011. I have called medicare, but all they can tell me what IS covered and have no information other than that. Had my consult and nutrition class...paid out of pocket to get things rolling in anticipation of the medicare approval. I am going to Clevland Clinic , Weston, Fl.
    Fabulous reputation and Doctors.....but they can't seem to help about this. Anyone waiting too?


  2. Gastric Sleeve Surgery With Weight Loss Agents
  3. #2
    Gastric Sleeve Member rylynn's Avatar
    I have had a gastric sleeve.
    Surgery date
    08/24/2011
    Surgeon
    Dr. Larry Hobson
    Join Date
    Sep 2011
    Last Activity
    10-14-2013 03:03 PM
    Posts
    561
    Said "Thanks" 25 Times
    Was Thanked 111 Times in 101 Posts
    Said "Welcome to Gastric Sleeve" 204 Times

    Default Re: Medicare approve Sleeve???

    my medicare was approved 2 days after I turned everything in to my doctor,,luckily i didnt have any problems..good luck
    <a href="http://www.gastricsleeve.com/weight-loss-ticker/" title="Click here to create your own Weight Loss Ticker"><img src="http://www.gastricsleeve.com/weight-loss-ticker/rylynn.gif" alt="Weight Loss Ticker" border="0"/></a>


    ~ doesn't think she'll ever reach her original weight, no matter HOW hard she tries. Hell, let's face it, 8lb 10oz is not very realistic is it?

  4. #3
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Surgery date
    12/27/2011
    Surgeon
    Dr. Robert Marvin
    Join Date
    Oct 2011
    Location
    Texas
    Posts
    201
    Said "Thanks" 7 Times
    Was Thanked 61 Times in 51 Posts
    Said "Welcome to Gastric Sleeve" 32 Times
    Blog Entries
    1

    Default Re: Medicare approve Sleeve???

    I don't know anything about Medicare, but I will say this. You can re-send everything certified mail with signature required (That way they can't say they didn't get it.) And you can write a letter documenting how long you've been waiting for their decision. (Send it with your information.)

    It is easy to say you called; Much harder to ignore a written letter. You will keep copies of everything. This way, you are establishing that you are serious and you want an answer or else. (Or else what? We'll find a way to file a great big complaint, and put some real names in it. lol)

    Good Luck

  5. #4
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Nanci Donovan
    Surgery date
    08/09/2012
    Surgeon
    USC Dr Crookes
    Join Date
    Feb 2012
    Last Activity
    09-17-2013 09:43 AM
    Location
    right now I Live in Temecula California
    Posts
    37
    Said "Thanks" 0 Times
    Was Thanked 0 Times in 0 Posts
    Said "Welcome to Gastric Sleeve" 1 Times

    Default Re: Medicare approve Sleeve???

    yes I am waiting....I have done all the Drs appoints...all the pre ops...everything is ready.....USC doctors said they will call me as soon as its approved by medicare I I will have it 3 days later....But look....I am so sick of this ....when are they going to approve it....
    1st they said march 1st,,,then they said between march 1st and the 31st......latest I got was between march 1st and July 31st....OMG....
    email me...gokiwi68@yahoo.com cheers...Nanci


  6. #5
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Nanci Donovan
    Surgery date
    08/09/2012
    Surgeon
    USC Dr Crookes
    Join Date
    Feb 2012
    Last Activity
    09-17-2013 09:43 AM
    Location
    right now I Live in Temecula California
    Posts
    37
    Said "Thanks" 0 Times
    Was Thanked 0 Times in 0 Posts
    Said "Welcome to Gastric Sleeve" 1 Times

    Default Re: Medicare approve Sleeve???

    how did u get it approved...I need to get approved sooooooo bad....cheers...Nanci


  7. Gastric Sleeve Surgery With Weight Loss Agents
  8. #6
    Gastric Sleeve Member rylynn's Avatar
    I have had a gastric sleeve.
    Surgery date
    08/24/2011
    Surgeon
    Dr. Larry Hobson
    Join Date
    Sep 2011
    Last Activity
    10-14-2013 03:03 PM
    Posts
    561
    Said "Thanks" 25 Times
    Was Thanked 111 Times in 101 Posts
    Said "Welcome to Gastric Sleeve" 204 Times

    Default Re: Medicare approve Sleeve???

    I had no problems getting approved with medicare.I started in June and by August was sleeved..I was the first to be approved threw medicare apparently..so now they are going to have to start approving all so keep fighting
    <a href="http://www.gastricsleeve.com/weight-loss-ticker/" title="Click here to create your own Weight Loss Ticker"><img src="http://www.gastricsleeve.com/weight-loss-ticker/rylynn.gif" alt="Weight Loss Ticker" border="0"/></a>


    ~ doesn't think she'll ever reach her original weight, no matter HOW hard she tries. Hell, let's face it, 8lb 10oz is not very realistic is it?

  9. #7
    Gastric Sleeve Member csmith2884's Avatar
    I have had a gastric sleeve.
    Name
    Christopher
    Surgery date
    01/24/2012
    Surgeon
    Dr. DiBenedetto
    Join Date
    Nov 2011
    Last Activity
    01-25-2015 09:28 AM
    Location
    between Rochester and Buffalo NY
    Posts
    57
    Said "Thanks" 24 Times
    Was Thanked 12 Times in 11 Posts
    Said "Welcome to Gastric Sleeve" 1 Times

    Default Re: Medicare approve Sleeve???

    I was set to be sleeved (with medicare ok ) and they pulled it 4 weeks before my surgery. My doc did not get paid for several he did from Oct-Jan. So after another doctor visit I went with RNY and have no complaints.





    Christopher

  10. #8
    Gastric Sleeve Member rylynn's Avatar
    I have had a gastric sleeve.
    Surgery date
    08/24/2011
    Surgeon
    Dr. Larry Hobson
    Join Date
    Sep 2011
    Last Activity
    10-14-2013 03:03 PM
    Posts
    561
    Said "Thanks" 25 Times
    Was Thanked 111 Times in 101 Posts
    Said "Welcome to Gastric Sleeve" 204 Times

    Default Re: Medicare approve Sleeve???

    awesome weight loss
    <a href="http://www.gastricsleeve.com/weight-loss-ticker/" title="Click here to create your own Weight Loss Ticker"><img src="http://www.gastricsleeve.com/weight-loss-ticker/rylynn.gif" alt="Weight Loss Ticker" border="0"/></a>


    ~ doesn't think she'll ever reach her original weight, no matter HOW hard she tries. Hell, let's face it, 8lb 10oz is not very realistic is it?

  11. Said thanks:


  12. #9
    Gastric Sleeve Member PCaz's Avatar
    I have had a gastric sleeve.
    Name
    Phil
    Surgery date
    11/19/2012
    Surgeon
    Dr. Sloan
    Join Date
    Mar 2012
    Last Activity
    07-22-2014 06:20 PM
    Location
    Northern Indiana
    Posts
    14
    Said "Thanks" 0 Times
    Was Thanked 7 Times in 4 Posts
    Said "Welcome to Gastric Sleeve" 0 Times
    Blog Entries
    1

    Default Re: Medicare approve Sleeve???

    Quote Originally Posted by rylynn View Post
    I had no problems getting approved with medicare.I started in June and by August was sleeved..I was the first to be approved threw medicare apparently..so now they are going to have to start approving all so keep fighting
    Do/did you have traditional Medicare coverage administered by Medicare, or a Medicare advantage plan, or another insurance in addition to medicare?



  13. #10
    Gastric Sleeve Member ChrisJ's Avatar
    I have had a gastric sleeve.
    Name
    Chris
    Surgery date
    12/11/2012
    Surgeon
    Dr. James Foote
    Join Date
    Feb 2012
    Last Activity
    01-16-2015 06:04 PM
    Location
    Eagle, Mi
    Posts
    138
    Said "Thanks" 1 Times
    Was Thanked 10 Times in 10 Posts
    Said "Welcome to Gastric Sleeve" 12 Times

    Default Re: Medicare approve Sleeve???

    I am waiting for Medicare approval also. On a CMS website it says that preliminary approval for the sleeve will come tomorrow, March 30 with final approval June 30. I am going to try and call them Monday. I am retired, fat, unhealthy and holding my breath. My WL clinic won't submit any paperwork until they are notified of the approval.



  14. #11
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Nanci Donovan
    Surgery date
    08/09/2012
    Surgeon
    USC Dr Crookes
    Join Date
    Feb 2012
    Last Activity
    09-17-2013 09:43 AM
    Location
    right now I Live in Temecula California
    Posts
    37
    Said "Thanks" 0 Times
    Was Thanked 0 Times in 0 Posts
    Said "Welcome to Gastric Sleeve" 1 Times

    Default Re: Medicare approve Sleeve???

    The results for Medicare and the Sleeve came out today...29th....it looks like its a yea but on a case by case situation....


  15. #12
    Gastric Sleeve Member PCaz's Avatar
    I have had a gastric sleeve.
    Name
    Phil
    Surgery date
    11/19/2012
    Surgeon
    Dr. Sloan
    Join Date
    Mar 2012
    Last Activity
    07-22-2014 06:20 PM
    Location
    Northern Indiana
    Posts
    14
    Said "Thanks" 0 Times
    Was Thanked 7 Times in 4 Posts
    Said "Welcome to Gastric Sleeve" 0 Times
    Blog Entries
    1

    Default Re: Medicare approve Sleeve???

    This is the link to the proposed decision CMS has made. It appears that it is not really been approved, however, it will be covered on a case by case basis that requires the surgery to be part of a clinical trial for CMS to study. There is a bunch of gobbledygook about the requirements that the general layman will have difficulty deciphering.

    cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=258&ver=3&NcaName=Bariatric+Surger y+for+the+Treatment+of+Morbid+Obesity&NCDId=57&ncd ver=3&IsPopup=y&bc=AAAAAAAAIAAA&

    Since I'm new, the forum isn't allowing me to use a URL, so you'll have to cut and past and add www(dot) at the beginning of cms.gov



  16. #13
    Gastric Sleeve Member Grace's Avatar
    I have had a gastric sleeve.
    Name
    Grace
    Surgery date
    08/22/2011
    Surgeon
    Portsmouth Regional Hosp
    Join Date
    Apr 2011
    Location
    New England
    Posts
    4,264
    Said "Thanks" 919 Times
    Was Thanked 1,296 Times in 1,005 Posts
    Said "Welcome to Gastric Sleeve" 5,008 Times
    Blog Entries
    26

    Default Re: Medicare approve Sleeve???

    Hmm, looks like the wheels of decision move slowly in DC... I take it all to mean you'd need to be in a study and once it IS approved it will be on a case by case basis but I'm no lawyer. But I've been in a study before, it was for the uterine freezing being done now for excess menstral bleeding. I don't see anywhere they are listing studies but if you are determined to get the sleeve and can travel a bit, I'd call around to the major metropolitan area docs and see if any of them is participating in the study - then see if they will accept you into it. If this isn't an option and you are very morbidly obese you might try to talk the docs into setting it up as a two part and then just don't go back (not sure if/how this would work) or just go ahead and have the RNY. While I'm obviously a huge cheerleader for the sleeve, I don't think waiting for the gov't is worth it if you are suffering from the extra weight. With all the health care nonsense and the elections, I'm going to doubt there will be much movement on this for the next year or so.
    But do see if you can find a doc in the study first!
    Wishing you well...
    Best NSV - fitting on a kid's amusement park ride with my 4 yr old grandson!
    CFIDS =Chronic Fatigue Syndrome) Also dx with post-bariatric reactive hypoglycemia; and chronic gastritis (both sleeve complications). Permanently disabled.
    Start weight 335, down to 218, up during gastritis. Have accepted there is no way to lose it with my hypoglycemia. Current weight 260. Currently doing 10 day sleeve reset and determined to get back down to my post surgical weight or close to it.

  17. Said thanks:


  18. #14
    Gastric Sleeve Member csmith2884's Avatar
    I have had a gastric sleeve.
    Name
    Christopher
    Surgery date
    01/24/2012
    Surgeon
    Dr. DiBenedetto
    Join Date
    Nov 2011
    Last Activity
    01-25-2015 09:28 AM
    Location
    between Rochester and Buffalo NY
    Posts
    57
    Said "Thanks" 24 Times
    Was Thanked 12 Times in 11 Posts
    Said "Welcome to Gastric Sleeve" 1 Times

    Default Re: Medicare approve Sleeve???

    For what it's worth, my options were wait and see, or get going. 97 pounds later I'm pretty happy I got going.





    Christopher

  19. #15
    Gastric Sleeve Member ChrisJ's Avatar
    I have had a gastric sleeve.
    Name
    Chris
    Surgery date
    12/11/2012
    Surgeon
    Dr. James Foote
    Join Date
    Feb 2012
    Last Activity
    01-16-2015 06:04 PM
    Location
    Eagle, Mi
    Posts
    138
    Said "Thanks" 1 Times
    Was Thanked 10 Times in 10 Posts
    Said "Welcome to Gastric Sleeve" 12 Times

    Default Re: Medicare approve Sleeve???

    Well, Medicare is out and self-pay is in. Now I have to find a good surgeon at a price I can try to scrape up. I think I will start a new thread and see if there are any well-experienced, well-loved surgeons state-side who charge around $10,000. There sure are a few in Mexico with rave reviews.



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