Insurance help

[Lori Woods]

Hello there everyone.
I was told by my bariatric center that Medicare will not cover both my band removal and the sleeve. She said I would have to pay out of pocket $6900 for my band removal and then use my insurance for the sleeve. But, she then told me I had to get the bypass because Medicare won't cover the sleeve.
I know for a fact there are several people who got both surgeries done together and paid fully by Medicare.
Is this lady pulling my chain?
I'm going crazy, I'm so upset right now.

 

[DianaCox]

"Pulling your chain?" No, she's lying out her ass. Not to put too fine a point on it.

They apparently want you to pay CASH for the band removal, and never even submit for coverage by Medicare (which pays poorly, of course). And they want to upsell you to an RNY, as a SEPARATE (more expensive) procedure. Nice folks.

Which "bariatric center" are you talking about?

And have you considered the failure rate of the sleeve as a revision surgery after a failed crapband? You should be considering a malabsorptive procedure, but NOT the RNY. In other words, a DS.

 

[chevtow]

I agree with Diana. Don't be one of the people with 3 surgeries someday if you can help it. Go straight to the top

 

[southernlady]

@Lori Woods She is LYING about the sleeve. Here is a thread listing the memo...
They do have a section that deals with non-covered options:

4. Sleeve Gastrectomy

Sleeve gastrectomy is a 70%-80% greater curvature gastrectomy (sleeve resection of the stomach) with continuity of the gastric lesser curve being maintained while simultaneously reducing stomach volume. In the past, sleeve gastrectomy was the first step in a two-stage procedure when performing RYGBP, but more recently has been offered as a stand-alone surgery. Sleeve gastrectomy procedures can be open or laparoscopic.

 

[Lori Woods]

"Pulling your chain?" No, she's lying out her ass. Not to put too fine a point on it.

They apparently want you to pay CASH for the band removal, and never even submit for coverage by Medicare (which pays poorly, of course). And they want to upsell you to an RNY, as a SEPARATE (more expensive) procedure. Nice folks.

Which "bariatric center" are you talking about?

And have you considered the failure rate of the sleeve as a revision surgery after a failed crapband? You should be considering a malabsorptive procedure, but NOT the RNY. In other words, a DS.

It's southern surgical in NC.
I have been thinking about DS as well lately, someone informed me of that option as well.

Admin note: Added link to surgery center

 

[Lori Woods]

I agree with Diana. Don't be one of the people with 3 surgeries someday if you can help it. Go straight to the top

I plan on calling Medicare myself, and changing centers.

 

[Larra]

@Lori Woods before you change centers (which is certainly called for given how you have been lied to) figure out what operation you want and THEN pick a surgeon who does that operation. This is esp important now that you are considering the DS, because as long as you go to a surgeon or center that doesn't offer the DS they won't tell you it exists, or will at best acknowledge its existence but tell you horror stories about what a bad operation it is. Having lived with the DS myself for 9 years now, I can tell you it's a great operation, though anyone considering it should be committed to the protein, vitamin and mineral requirements to maintain good health.

The DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for resolution of almost all comorbidities. It is definitely covered by Medicare. In most cases it is possible to remove the lap band and do the DS at the same operation.

@chevtow is right, don't have an operation that is unlikely to work for you and then find yourself looking into a THIRD bariatric surgery a year or two from now. We've seen that happen. You can avoid that if you become well informed now and make the right choice.

 

[Lori Woods]

@Lori Woods before you change centers (which is certainly called for given how you have been lied to) figure out what operation you want and THEN pick a surgeon who does that operation. This is esp important now that you are considering the DS, because as long as you go to a surgeon or center that doesn't offer the DS they won't tell you it exists, or will at best acknowledge its existence but tell you horror stories about what a bad operation it is. Having lived with the DS myself for 9 years now, I can tell you it's a great operation, though anyone considering it should be committed to the protein, vitamin and mineral requirements to maintain good health.

The DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for resolution of almost all comorbidities. It is definitely covered by Medicare. In most cases it is possible to remove the lap band and do the DS at the same operation.

@chevtow is right, don't have an operation that is unlikely to work for you and then find yourself looking into a THIRD bariatric surgery a year or two from now. We've seen that happen. You can avoid that if you become well informed now and make the right choice.

@Larra thank you so much for the information. I am still researching all the different surgeries to see which is best for me. I appreciate everyones input.
Thank you so much