Good News! Need More Help!

8/6/2013

Hello!

My doctor's want me to have weight loss surgery, but hubby's Ins. co excludes it from his plan all together even if it is medically necessary. I have Medicare as my secondary insurance. Does anybody know how or if Medicare would help or even pay for the surgery?

8/7/2013

Hello!

I called Medicare this morning and got good news. They said that even if my Hubby's ins doesn't pay, they would have to file with his first and then with medicare and they would pick up and pay for the surgery. There is a deductible of $1,184.00. I am nervous and excited. I don't even know what to do next in this process. Do I go to PCP and get them to write letters of Medically Necessity? What is the next step for me? Help???

Your PCP's letter is a good start. You probably need to ask Medicare if you are allowed to go out of state or must find a surgeon who accepts Medicare in VA. There's a list of trusted DS surgeons on www.dsfacts.com. You attend the surgeon's seminar, schedule a consult, and they start you on medical tests. The tests are sent to the surgeon's office and they start dealing with insurance.

--gina

Hi Gina! The man from Medicare said I could have my surgery in any state I chose. I made sure I asked that question, because I was looking at surgeons in NC.  Thanks for responding :)

That's great. Did you ask medicare if there were any other requirements? Some regular insurance companies want proof of a 6 month supervised diet. (some don't). It's great your PCP is behind it. 

Most of the Doctor's offices will walk you through any requirements so maybe you are at the Doctor picking stage.

Congratulations.

Hello PeteA! Thanks for responding! I called Medicare again today and they said there is no 6 month supervised diet. The way things are looking with my health issues and the NSAID's I take I will have to have the DS surgery. I have found a doctor  that I have been reading on line about that I like, but It may be first of the year, because I want to talk to my Primary care doc, my pain management doc and my Psychiatrist and my hubby doesn't have much vacation time left. I am not in a big rush and this year is really flying by. So I want to do all my reserach and discuss it all with my doctors first before making a appt with a consult with a surgeon. Thanks for responding! :)

I don't know where in NC you are looking - I had mine done by Dr. Ranjan Sudan at Duke and would highly recommend him.  I'm just 3 weeks post op.  You do not have to do the two week liquid diet with him.

Hi Nancy!I can't believe it! Dr. Ranjan Sudan is the Doctor that I have been reading up on because he does the DS surgery. I am so glad I found someone that has had him as a surgeon.

You won't regret it!  He is very quiet, but he always asks if I have more questions for him.  Make your list of questions, make your appointment and see him.  His office staff is awesome as well.  He uses a laparoscopic robot to do all of his DS surgery and I had NO PAIN afterward.  Lots of gas discomfort, but that passes in a couple days.  My whole experience, even the stay in the hospital, was good.    If I can be of any help, please let me know, ok?  I also work at Duke so I'm in the area.

I know you're still in the research stage, but I would go ahead and make an appointment to see the surgeon if possible.  There are a lot of steps to take and information to learn once you talk to the surgeon.  You are right to take it slowly if you can, there is a LOT to learn!  

Best of luck to you - this forum is absolutely the best place to be for help in your education!