Keystone Mercy

Hi there, I'm new here. Does anyone know if Keystone Mercy pays for the gastric sleeve? I still haven't met with my surgeon but I have my mind set on the sleeve. I've been looking around here and it seems the few people I've seen with KM had the Roux-en-Y.

Welcome to the PA boards!

Have you called member services to ask which procedures they cover.  The 800 # is on the back of your card.

Ida

Thank you Ida! 

Member services are of no help. It's like going in circles (literally). It's like they don't know or don't want to let you know, I've called more than once... such a headache. 

Anyway, I've had my initial visit with my surgeon. He said KM rarely coves VSG and that by the time of my surgery they may.

When on the phone with member services if you feel you are getting no where, ask to speak to a supervisor, manager, or director.

I didn't think they do, as far as I'm aware they cover what is the norm for now.

If your surgeon can document the need for VSG over the other proceedures he/she can always go to a peer to peer review if he/she is up for that. No guarantee it would be approved even after all that however peer to peer review is an option.

Angel, do they have a website that lists covered services? Or did you receive something in the mail?  If there is a website and you give me the link, I may be able to help you determine coverage. 

Lisa,
Keystone Mercy is Managed Medicaid.  It is not a commercial plan.  What is covered under Medicare KMHP's fee schedule is approx 50% of Medicare for reimbursment.

Angel Eyez, Pennsylvania Hospital is one of the few hospitals in Philly that accepts Keystone Mercy.  Go to their website which is under Penn Care and see if there is someone there who might be able to help you.

Have you spoke with Dr. Weistein one on one about the sleeve?  What is his recommendation for you?  I had my surgery 4 years ago and they only offered RNY.   I really wish that I had done more research as I don't know if I would have gone that way, but it is very easy to be a Monday morning quarterback, lol.

I do know that the hospital is expanding their Bariatric Unit.  Perhaps that is why David told you to check back.

Good luck to you on your journey.  I am sorry I can't give you the direct answer.

Jeanne