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I had a VSG a year and a half ago and may need a revision. Does insurance cover it?
I have BCBS of Alabama. I was soooooo shocked to find out today that I got my approval after only three days after submitting it to them (and one of those days was Thanksgiving! lol). I am so excited but nervous! Just happy to finally have an approval because I was afraid they would deny me the first time.
Hi,
I was hoping someone can help me, I am fulfilling my requirements to receive the lap band. I started back in May 2012 and have been denied 3 times (appealing) since I haven't had six months documented weight loss. This will be my last month for a weigh in and I am just getting very nervous because I lost weight 5 out of the sixth months. One month I did gain weight, due to the wonderful things women go through. I am really nervous that I am going to get denied I am trying so hard and have been really struggling, it is not coming off easily and not staying off easily.
I guess what I am trying to ask, has anyone gone through the six month process and gained weight but got approved or denied?
I am 21 years old and have been dealing with weight since I was 9. My BMI is way over 40!
Thank you for any advice or help in advance!
Am gathering some good information about Medicare coverage of gastric sleeve here in CA. Have opened a dialog with my Medicare contractor, Palmetto. Have just today e-mailed them, and my Dr. some web based info. for them to review. i am including them here for review by the OH community. The .pdf file will need some decyphering by your insurance dept., but looks promising.
http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=258&NcaName=Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity&CoverageSelection=National&KeyWord=obesity&KeyWordLookUp=Title&KeyWordSearchType=And&where=index&nca_id=219&basket=nca*3a$00397N*3a$219*3a$Surgery+for+Diabetes*3a$Open*3a$New*3a$5&bc=gAAAABAAIAAA&
http://asmbs.org/2012/06/access-to-care-alert-the-cms-final-decision/
http://asmbs.org/2012/11/important-cms-updates/
http://s3.amazonaws.com/publicASMBS/top5/November2012/CMS_Sleeve_Update_November%20_2012_MAC_Territories_and_Contacts.pdf
Addition info. is appreciated.
Update 11-22-12
Additional final determination by CMS
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8028.pdf
There are resources on the Obesity Action Coalition (www.obesityaction.org) site which might assist you (and you can JOIN!). While you are preparing that material you should request Dr. Anthone's office to submit the pre-authorization request now, even if it gets denied, so you have something concrete to appeal - - it gives you more leverage. Tell him that Walter says "Hi" . . . good luck!
Walter Lindstrom, Jr.
[email protected]
LINDSTROM OBESITY ADVOCACY
WWW.WLSAPPEALS.COM, 1-877-99-APPEAL
PS: Tell Dr. Byrne that Walter says "hi"! 
Walter Lindstrom, Jr.
[email protected]
LINDSTROM OBESITY ADVOCACY
WWW.WLSAPPEALS.COM, 1-877-99-APPEAL
The UHC medical policy is changing effective 12/1/2012. I posted a blog on my site which you should look at so that you have the most current information.
http://wlsappeals.com/category/walters_lindstrom_obesity_adv ocacy_blog/
I think that will help you. Good luck!
Walter Lindstrom, Jr.
[email protected]
LINDSTROM OBESITY ADVOCACY
WWW.WLSAPPEALS.COM, 1-877-99-APPEAL
Absolutely contact UHC. We have UHC and my husband's requirements are different than a coworkers depending upon many variables. My VDH has only needed cardio exams, nut, psych,bloodwork and the 10 day prediet. A coworker's husband had to go on the 6 month diet. The only reason we can come up with is because he's never tried any other diets.
But, my plan will be different than yours depending upon what your company requests.
Good luck!
Thanks, Diana
“All our dreams can come true – if we have the courage to pursue them.” –Walt Disney
Hockeymom87 · 0 replies · 663 views
