GES appeals

Gastric Electrical Stimulation (GES)

Enterra^® Therapy

On this page you will find information to help Americans and Canadians with coverage for GES.

In the USA:

Gaining insurance coverage for GES may be difficult. The good news: in nearly all situations, insurance coverage is awarded. Further strides have been made. Many large, US, for-profit insurance providers now cover GES as a medical necessity. GES is also covered by Medicare in all states in the USA.

You are not alone. Should you need assistance for filing an appeal for GES, here are some resources:

Medtronic (Enterra^® Therapy) has wonderful resources to help you navigate an insurance appeal.

Jennifer Jaff provides legal guidance to help with GES appeals. She has successfully helped many gastroparetic patients win insurance appeals.

In Canada:

Those patients, for whom Enterra Therapy has been recommended, have had to travel to the US and pay out of pocket for implantation. One lone surgeon in Quebec will perform the procedure on a limited number of patients each year.

Fortunately, GPDA has made great strides in Alberta. Commencing in early 2008, Dr. Christopher Andrews, at the University of Calgary (U of C) division of GI medicine, will launch a pilot project enrolling Type I diabetic gastroparesis patients in a clinical trial with GES.

In addition, any Canadian idiopathic gastroparesis patient who is currently implanted with GES, should be able to access the U of C group for assistance with any problems with their implanted devices.