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Gastric Sleeve/Medicaid

K

katie427

New Member
Hi Everyone,
I am new to this site and looking into a VSG in Milwaukee, WI. When I called my surgeon's office at Aurora Sinai I was disheartened to hear that Medicaid doesn't cover this procedure. I was looking on youtube at some seminars and one of the surgeons said Medicaid should start covering it sometime this year. Does anyone know when this might be or have any other information regarding this topic? Thank you in advance. Hope you are all well!
 
FYI: I have badgercare plus United Health Care community plan....if that makes any difference. I have a bmi of 44 with hypertension and depression so I feel that I need to lose too much weight for lap band and afraid of the malabsorbtion component of roux en Y. I appreciate your feedback. Thank you.
 
I think you misunderstood my post. I am looking to have the sleeve done. Was simply stating why lap band and roux en y are not for me:)
 
Hi Katie, Welcome to the board. I'm afraid I have no knowledge of Medicare, but you did say you had Badgercare? Is that the name for medicare in Wisconsin? Anyway, I hope that you can get the insurance part squared away. Good luck and keep us informed.

Frank

:cool:

 
Frank,

Medicare is for old people like me and it is a federal program. Medicaid is a state program for the medically needy and in many states for children to get care. The two programs are different in what they will pay for and each state may be different as well. Katie, I hope they do get approval for WLS in your state. I think in the long run it would save states a lot of money and promote a healthier life style. Too bad they don't listen to us.
 
Welcome. I know Medicaid covers VSG in NY. Not all states cover all services. That is in all medical care not just WLS. I hope that soon all states will see the cost effectiveness of WLS compared to ongoing medical issues. In the end it is all about money and WLS makes better financial sense. It might just take some time for your state to catch up. It is disgraceful that in this country people are still being denied medical care. Medicare also is the health insurance for people who are disabled who have a work history. Would your medical conditions be severe enough to qualify? Medicare is a Federal program that covers WLS in all states. Wishing you the best. I would request a fair hearing on the decision and try to fight it out. I have helped numerous client's do this when they have been denied services. Some we win some we lose. It is worth a try.
 
Hi Kim... I am scheduled for WLS on 01/08/2014, but struggling with what to do. I REALLY prefer the options w/VSG, but have a surgeon who REALLY prefers RNY. You seem to be doing very well in terms of weight loss. Any tips? Also, any ideas on how to handle the surgeon? Thanks!
 
I had gone for a consultation with a surgeon about 10 years before I had surgery. At that time he was doing RNY, lap band and DS. I decided against it for numerous reasons. I was not comfortable with possible long term effects of not absorbing all the nutrients I was eating. I also had some concerns about reconnecting of intestines. I want to add that so many on this forum have been successful with RNY and have it for the same reasons I didn't want it. It is really an individual choice. Some feel the dumping is an extra safety net to deter them from eating certain foods. Fast forward 10 years and after continuing to struggle with yo yo dieting, I started to hear about this sleeve. I went back to the same surgeon to learn more about the VSG. He had in fact stop doing RNY and was doing more of VSG. This is still a very serious surgery. After all they are removing about 75% of your stomach. So it is restrictive. I think all WLS patients face the same challenges. After the honeymoon phrase slows down if you have not made the physical, emotional, behavioral and for me spiritual changes there is a chance of regain. Even with surgery this is hard. As far as your surgeon goes I would ask why he prefers RNY to the sleeve. I think if you are leaning toward the sleeve then you should see another doctor for another opinion. This is a major life decision and one you need to make for yourself. Do a lot of research and talk to people who have had both. Most RNY patients lose faster. That was not an issue for me. I have lost weight quickly many times. I lost every month some more than others. I stopped losing in Sept and decided I was in the maintenance phrase. It is possible to lose all your weight. I am almost 18 months post op and am learning how to live without dieting. I still weigh my food and most days log it. I have figured out my calorie intake needs to be around 1200 to maintain this weight. This can vary a bit depending on my exercise level. Whatever you choose know that you will need a good support system to get you through the challenging times. Wishing you clarity before you make this life changing decision. PM me anytime for more info
 
Thanks Kim. Just to clarify, this has been a long journey for me, as well. I came in quite set on VSG, but the surgeon (very highly regarded in the state), although willing to do VSG, prefers the "numbers" in terms of the 2 surgeries. As we know, RNY is the gold standard surgery, and it is true that there are not a lot of numbers when it comes to VSG being used as a WLS stand-alone, but what I am seeing overall is that the bottom line for maintenance is behavioral changes- RNY or VSG. I simply have the same concerns with rerouting my GI system and long term side effects. I've spent the last couple of months working on those behavior changes- mostly recording my intake (even when its bad), etc. I've been attending support groups on a monthly basis, and am in nursing school as well, so have a lot of input from nurses, including those who work with him. My biggest difficulty at this point is coming to him in a way that backs my choice as factually as possible so that he can respect my wishes. He is REALLY good, so I want him, but just feel quite inadequate when discussing the options.
 
jrobbin, welcome to the forum. I too had the sleeve about 7 weeks ago. I was lucky in that my surgeon and I came to a mutual decision that the sleeve would be the best for me. One thing that tipped the scales-- I take Aleve daily for arthritis pain. He said I couldn't take any nsaids (ever again) with gastric bypass, but I could resume my Aleve one month after surgery after the sleeve gastrectomy.
One negative about the sleeve--you are supposed to be at higher risk for GERD afterwards, which I didn't have before. I don't show any signs of it so far, but he's got me on Prilosec OTC daily to reduce acid. That may be helping.
 
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