Medicare DOES cover VSG, under "some" privatley managed plans!
Every since hearing Simone vsSimone broke the news that she uncovered Medicare now covers the VSG, I have been researching to discover exactally how this applies. Here's what I have uncovered.....
If you call Medicare and ask them if the Verticle Sleeve Gastrectomy is covered, and provide them with the CPT code for the VSG (43775), they will inform you it is and provide you with a fee schedule. However, what they wont tell you is it's NOT covered under vanilla federal Medicare. For reasons I have yet to discover, the coverage only applies to select private Medicare (part C) plans.
Right now until December 31, Medicare is in it's open enrollment phase. That means you are free to select any private Medicare plan offered in your area. For those of you who are low income and the state pays your monthly Medicare part B premium, it should cover your new provider choice. Check with your social worker for the details.
To determine who offers plan in your state/county go to the link below and answer the questions. After you have answered the questions it will generate a list of those companies who offer coverage and are authorized to sell you a replacement Medicare plan.
www.medicare.gov/find-a-plan/questions/home.aspx
With this generated list, you will need to call each Insurance company offering the plan. Speak to someone in sales. When you get a agent on the line, let them know the deciding factor in selecting them as a provider hinges on their coverage of the Verticle Sleeve (43775). Ask them to verify if their specfic Medicare plan covers this. Not all sales agents will be able to determine this on their own. Request that they contact a medical examiner, customer service, whomever within the company that can provide a firm answer. I found it helpful to STRESS you are not seeking a verbal approval specfic to you. Your only attempting to verify that "if" your doctor submits you for a VSG and the medical examiner agree's with your surgeons case that the VSG will be covered becuase it is a surgery option they offer with criteria and guidelines.
Not all sales agents will be able to answer this question on your initial call. I have found many will need to make some emails and do some reaserch to be SURE that they give you a accurate answer. Be sure to get their name and phone extension and ask that they call you back. Now most of these folks in sales work off a comission so they will greatly apperciate you calling and working ONLY with them (so they dont have to split it with another sales agent).
With some time and effort, you might just find a Medicare managed care provider who does cover the VSG. Speaking personally, I believe I found my provider here in Minnesota (Health Partners) who is underwritten by a company called GHI (Group Health Inc) that covers the sleeve! I will know for sure by the end of the week. I will make a seperate thread discussing the details of my outcome in the Minnesota forums.
I hope this prooves useful to those of you with Medicare who are seeking a VSG. :)
~Greg
If you call Medicare and ask them if the Verticle Sleeve Gastrectomy is covered, and provide them with the CPT code for the VSG (43775), they will inform you it is and provide you with a fee schedule. However, what they wont tell you is it's NOT covered under vanilla federal Medicare. For reasons I have yet to discover, the coverage only applies to select private Medicare (part C) plans.
Right now until December 31, Medicare is in it's open enrollment phase. That means you are free to select any private Medicare plan offered in your area. For those of you who are low income and the state pays your monthly Medicare part B premium, it should cover your new provider choice. Check with your social worker for the details.
To determine who offers plan in your state/county go to the link below and answer the questions. After you have answered the questions it will generate a list of those companies who offer coverage and are authorized to sell you a replacement Medicare plan.
www.medicare.gov/find-a-plan/questions/home.aspx
With this generated list, you will need to call each Insurance company offering the plan. Speak to someone in sales. When you get a agent on the line, let them know the deciding factor in selecting them as a provider hinges on their coverage of the Verticle Sleeve (43775). Ask them to verify if their specfic Medicare plan covers this. Not all sales agents will be able to determine this on their own. Request that they contact a medical examiner, customer service, whomever within the company that can provide a firm answer. I found it helpful to STRESS you are not seeking a verbal approval specfic to you. Your only attempting to verify that "if" your doctor submits you for a VSG and the medical examiner agree's with your surgeons case that the VSG will be covered becuase it is a surgery option they offer with criteria and guidelines.
Not all sales agents will be able to answer this question on your initial call. I have found many will need to make some emails and do some reaserch to be SURE that they give you a accurate answer. Be sure to get their name and phone extension and ask that they call you back. Now most of these folks in sales work off a comission so they will greatly apperciate you calling and working ONLY with them (so they dont have to split it with another sales agent).
With some time and effort, you might just find a Medicare managed care provider who does cover the VSG. Speaking personally, I believe I found my provider here in Minnesota (Health Partners) who is underwritten by a company called GHI (Group Health Inc) that covers the sleeve! I will know for sure by the end of the week. I will make a seperate thread discussing the details of my outcome in the Minnesota forums.
I hope this prooves useful to those of you with Medicare who are seeking a VSG. :)
~Greg
I'm going to print this out and hand carry it to my surgeon's office tomorrow since I have an appointment. I think the information is worth them checking into! Thank you so much for sharing!
I was a self pay because I was told Medicare didn't pay for it. Medicare is my primary, but I have supplemental insurance, so I'll be interested to know if they will pick up the tab!
HUGS!
I was a self pay because I was told Medicare didn't pay for it. Medicare is my primary, but I have supplemental insurance, so I'll be interested to know if they will pick up the tab!
HUGS!
HW: 335 SW: 279 GOAL: 150 ~ or less.
Your welcome Leanne. Here is a real black and white document (see below) outlining Sleeve Gastrectomy as a covered procedure under Medicare! Unfortunatley for a majority of us, GHI's Medicare program is only available in the New York state area. This company cannot be the only one out there.
www.ghi.com/pdf/MedTech_Database.pdf
As you guys find new privately managed Medicare programs that cover the VSG, please be sure to come back to this thread and share the good news with the rest of us.
www.ghi.com/pdf/MedTech_Database.pdf
As you guys find new privately managed Medicare programs that cover the VSG, please be sure to come back to this thread and share the good news with the rest of us.
I have Medicare through SecureHorizons and was completely covered for my VSG in Feb. 2009. I did lots of calling around to find out if it was covered at the time and got lots of different answers. The insurance biller in my doctors office knew in advance it would be covered and got approval within 1 week!
The OP is correct, find a Medicare managed care provider who does cover the VSG. These are usually known as Medicare Advantage plans.
Good luck to all!
The OP is correct, find a Medicare managed care provider who does cover the VSG. These are usually known as Medicare Advantage plans.
Good luck to all!
Original surgery: VSG Feb. 2009
REVISED TO RNY FEBRUARY 2016
Height: 5'7"
Start weight: 252. Current weight: 120
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