Calif. medicaid and VSG

gwheezy41
on 11/10/08 11:02 pm - Fullerton, CA

Hi I just went to my 1st consult with surgeon and he does not know if the vertical sleeve is covered, So he told me to make a second choice if it is not covered. But I don't want any thing else. So is there anyone out there that is on medicaid in California that has had the sleeve? Please help me! Thank you....Virginia

(deactivated member)
on 11/12/08 3:23 pm - sunny, CA

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=160&

Sleeve Gastrectomy

Sixteen commenters referred to sleeve gastrectomy, all with positive comments. Twelve were professionals and 4 were patients. One commenter referred us to papers on this procedure and we reviewed them. This data as well as other data in the literature are sparse or of poor quality. The level of evidence has resulted in the marked decrease in use of this one-time popular bariatric procedure. We again find that the data is insufficient to determine any health benefit.

The evidence is not adequate to conclude that the following bariatric surgery procedures are reasonable and necessary; therefore, the following are non-covered for all Medicare beneficiaries:

open vertical banded gastroplasty;
laparoscopic vertical banded gastroplasty;
open sleeve gastrectomy;
laparoscopic sleeve gastrectomy; and
open adjustable gastric banding.

Here is Medicare's website. It states specifically that they do not cover the VSG. Have you looked into getting the DS? The VSG is the first part of the DS, the duodenalswitch is the second. The DS offers malabsorption so you can maintain your weight loss easier. The surgery has been done since the 80s and is now covered by most insurances' and Medicare. Check out the DS board, you are very fortunate to have Medicare cover the DS, I am currently going through appeals with my insurance trying to get my DS approved. I was already approved for the RNY but know I wouldn't be able to live with that surgery. Best of luck

Calif. medicaid and VSG

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Calif. medicaid and VSG