VSG,Nsaids, Medicare

It seems to me that VSG is the best option for people like me with Arthritis that are taking Nsaids and other Arthritis meds, like Methotrexate, Humira and the like. It's hard to understand why Medicare wont cover this procedure. I've heard that they are going to make a revision to the policy now that VSG has it's own CPT Code (43775). Anyone got any news on this?   I want to get this weight off of me so badly but RNY seems like it might be a ticket to the pain train since no Nsaids are allowed. I tried contacting Medicare and the rep was only able to tell me what I already knew, that they didn't cover it... duh!  So if anyone has had any positive results getting VSG covered with medicare I would love to know how you made it happen. I feel like it's medically necessary for me...  I have a consult scheduled with my WLS Dr. on the 12th to see if I can work around this somehow. I've considered WLS for 2 years now and without a lot of hope until I read about the VSG procedure. It seems like the perfect solution for someone in my situation, obese and arthritic.

I have RA too &  I totally agree with you that VSG is the best option for serious arthritis sufferers.  I never even considered wls until I found out about the VSG.  My primary got really excited when I told her about it and so did my Rheumatologist.  I heard that in August that Medicare no longer considered the VSG as experimental and that the coding changed to 43775, (there's a posting about that on the Insurance forum).  I was told that UHC covers it now so I am waiting to see if my Medicare Advantage plan well cover it this year.  Good luck to us both and everyone else in our boat who are waiting!!

Medicare doesn't cover the VSG, because they don't feel that it's been around as a stand-alone procedure for weight loss. Have you considered the DS? It has exactly the same stomach as the VSG, so you can still take NSAIDs---and it's been shown to give the very best long-term results of ANY form fo WLS, especially for those of us with a starting BMI greater than 50.

I just called Medicare and they cover DS which is what I am getting. After all of my research it is shown to have the best long term results both in weight loss and weight regain. I have RA and was told that the DS and VSG were my only options. Good luck!

Henry Ford just received an announcement that Medicare will cover VSG in MI.  I believe if the surgeon recommends it, you should be covered????

medicare now covers