DISAPPOINTED

I' am very disappointed, someone from my doctor office called and told me the stomaphyX procedure was not cover by medicare and proabley  wouldnt be cover for another year because of  the  the procedure being so new.  SO COME ON PEOPLE ANY SUGGESTIONS AS TO HOW I CAN GET IT DONE.  I DON'T HAVE ANY MONEY

I dont know if you qualify for medicad in your state but I do in mine and they cover other revisions. If you have kids it is worth checking into.

no, i don't have medicaid, i have medicare because i'm a senior and don't have dependent children.  but i really appreciate your input.

thank you i will check with the hospital.  your very informative if  you come up with something else, please e-mail me. i am  in need of a revision before i gain all my weight back.  i constantly stay hungrey and i know it not in my head.

Hospitals have financial programs based on you income where they cover part of the treatment you receive.  Check into that with the financial department.  I know that 2 family member was covered at 100% after medicare paid their portions.  I believe that would be the same if the procedure was not covered by your insurance provider.  There was also a study by the Mayo Clinic (I think) and the Cleveland Clinic participated called Restore  which tightened the stoma.  Maybe you would qualify if there are any hospitals participating in your area.  I would look into it.

can they code it under CPT 43999, which is called something like "Unlisted procedure, Stomach" I have heard of one or 2 people getting it covered, but that was with a BCBS plan.  and that was 3rd or 4th hand that I  heard it, so I am not sure if it's even true. GOOD LUCK!!!

Have you looked at other types of revisions?  I was interested in stomaphyx because I thought for sure mine was stretched out.  I gained back 50 pounds and was hungry all the time.  I went to my surgeon and he did an endoscopy.  It turns out I have a gatro gastric fistula, which is the culprit for the weight gain and my severe acid reflux. Because this is considered a complication and it is detrimental to my health to have it repaired, my insurance won't even fight me on it.  The office manager at my surgeon's office made sure that when the did the pre-authorization it was NOT coded as obesity treatment, but it was a medical condition requiring treatment. It's worth looking into.  Good luck!

Can you tell me what exactly is a gastro gastric fistula?