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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.
walter@lindstromadvocacy.com
LINDSTROM OBESITY ADVOCACY
WWW.WLSAPPEALS.COM, 1-877-99-APPEAL
PS: Tell Dr. Byrne that Walter says "hi"!
Walter Lindstrom, Jr.
walter@lindstromadvocacy.com
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.
walter@lindstromadvocacy.com
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!
Hello everyone.. I was denied from Aetna on Sept 17 2012... after 6 longs months on the program to get approved. I was denied due to not having 2 years worth of weight history. My BMI is 63 and I'm 24!! that beyond needing this surgery!! Finally after 2 months of being depressed I've decided to see what can I do to get approved. I would love if someone can help on writing or brainstorming the perfect letter to get approved. If anyone has pointers or the best practice to writing this letter please message me..thanks
on 11/5/12 1:56 pm - Goodyear, AZ
Do you know what Medicare's specifcs are on this criteria?
you should contact your insurance company and request this info. every insurance company is different some require a 6 month supervised diet history others only 3 and others none at all just proof your bmi has been over 40 for a certain period of time. The only way to be sure is to contact united and ask what are the requirements.
My employer's health insurance (self insured) excludes WLS of any kind. I am gearing up to go after them to cover it. They are big on employee health and have all kinds of programs. I also discovered from the doctor's office that they used to cover it.
I am going to put together a package with information to present to the VP of HR that is in charge of this stuff. Has anyone seen such a package out there in the world? Has anyone created one? Does anyone have data/information that I can utilize to create this?
As I don't have the money and will have to 2nd mortgage the house, etc. I am pretty determined to beat these bushes until the money falls out.
Any and all help appreciated.

Read more: http://www.weightlosssurgery.proboards.com/index.cgi?action= display&board=mbdata&thread=5642#ixzz2BOBcoB7U
"Let us not glide through this world and then slip quietly into
heaven, without having blown the trumpet loud and long for our
Redeemer, Jesus Christ. Let us see to it that the devil will hold a
thanksgiving service in hell, when he gets the news of our departure from the field of battle." - C. T. Studd