Hello- I am scheduled for surgery for the sleeve on the 26 of this month. I am concerned because my insurance (Medicare) ONLY COVERS lap band and gastric pass. I have only 9 days to get answers for an alternative. I am also confused about the qualifications for the sleeve as far as pre- existing conditions. I have gotten 3 different answers from a nurse the internet and medicare.com if there is anyone out there with my issues PLEASE respond. I am a nervous wreck and the does not help the situation. Thanks
Insurance complications
- Thread starter Janet Kos
- Start date
dianeseattle
Member
What are your pre-existing conditions?
TraceyT
Member
Hi Janet!
You can ask 3 different people in this group and get 3 different answers. Have you talked to someone who handles the insurance issues for the weight loss clinic or the place you go to see your surgical team? Nurses who don't deal with insurance issues will not know the correct answer. The internet may not be the best place to get the answers either.
I urge you to talk with the person who handles all the insurance issues where ever you will be having surgery or the WLC that you go to.
There are 3 people at the WLC I go to that do nothing but handle insurance for WLS patients.
With my insurance - I had to have a BMI of 35 or greater and 3 comorbidities - I was diabetic - high cholesterol - asthma. Of course I had more than 3 but they required 3. If I had a BMI of 40 or higher they didn't need the comorbidities.
I originally went in thinking I wanted the sleeve. Once I met Dr. McNatt, he explained the surgeries to me and decided that I would be better served by getting bypass instead of the sleeve. He originally said I would have better results with duodenal switch in as far as becoming a non-diabetic after 29 years. But the insurance requirement for that was BMI in the 45-50 and weigh over 300 pounds - I weighed 220.
I hope they get everything figured out for you sooner rather than later! I wish you the best of luck!
Last edited:
Roseanne37
Member
Janet, First of all, I would definately call your Dr.'s Office and speak to someone who handles the insurance claims. I had my gastric sleeve done in August of this year and I am on Medicare. I had absolutely no problems with insurance. It's always good to talk to the office, but I believe that Medicare is Medicare.