VSG Coverage?

 Hello. I have some questions. My insurance is Medicare and Medicaid. I know that the CMS is reviewing and making a final decision by the end of June about covering or not covering VSG, but also read the memo that suggests the sleeve will only be covered in research clinical trials. Very disappointing. BUT, I have to say how confused I am about something. I've read a couple examples of people that HAD their sleeve covered because they convinced CMS with the help of their doctor that they needed the sleeve instead of the other covered surgeries in order to continue taking necessary medications like NSAIDS which can not be taken with the covered surgeries. I feel like coverage CAN happen if you find the loop holes, but feel like doctors and office staff is against trying to help with this. LIke they are the speedbumps in the road. Might never get covered even if I do appeal and try this approach, but shouldnt we ATTEMPT to get it covered instead of assuming they will say NO and not bother with it? Has anyone had luck getting approval? If so, how did you? I want this so much but can not afford self pay because I dont think I could get enough credit or loans to self pay! I really want to find a way to get an approval. I went for Lapband, was literally sent home after getting the IV on the way to surgery because I had an unexplained fever. Probably the best thing that happened to me in hindsight. I read such horror stories of the band! I am SET on wanting VSG, so what can I do???????? Thank you

ALSO, if you have an insurance company that covered your sleeve? Can you share which one please? I might have to go that route if nothing else works. THANKS again

Hi Gypsy,

While Medicare is a federal program and therefore administered the same no matter the state in which you live, Medicaid is administered through each state, so 'answers' can vary state to state. That said, I would try cross-posting  your to the Main, Insurance and VSG forums to see if anyone else has had some experience that might help.

In regards to your question about if you should appeal so that you can have the VSG, if I were in your position, I would have my PCP, Orthopedic, and Bariatric phsycians all write on my behalf to appeal the decision. The worst you'd end up with, is the same denial you already have, right?

 

 Thank you for the reply, and YES you are correct. An appeal with a denial is still a "try". The only problem I have right now is that all my doctors and even the surgeons in this area are telling me that it isn't worth trying to appeal because the answer is always NO, and I would be wasting more time. If I had the $13grand to self pay on hand, this would never be an issue. Thanks again