Hello Members,

On a daily basis we get calls from members in desperate need of surgeons that will accept Medicaid and or Medicare for Bariatric surgery.  It breaks our hearts when we have to say "we don't know of any surgeons in your state we can refer you to". 

Can you please help us? If you know of any surgeons in your state that accepts Medicaid and or Medicare, will you list their:

Name

If they accept Medicare and or Medicaid

Phone number

Facility

Address

This list will remain here for our members to access and use.

Thank you so much!!!

ObesityHelp,

Member Services

i'm on medicare, and Dr. Deveney at OHSU did my surgery.  He is at OHSU.  He comes highly recommended.  I loved the hospital and Dr. Deveney and his staff.  I felt in good hands and have excellent care.  In the end, I think I owed less than 900 dollars.  It was the best 900 dollars I have ever spent in my life!  Hope this is helpful information!

Drs. Clifford Deveney, Robert O'Rourke, and Bruce Wolfe Oregon Health and Science University (OHSU) Surgical Weight Reduction Program Digestive Health Center 3303 SW Bond St. CH6D Portland, OR 97239 503-494-1424 800-222-6478 x-1424 503-418-4189 (fax) E-Mail:  w8reduce@ohsu.edu URL: http://www.ohsu.edu/health/page.cfm?id=10085 OHSU accepts Medicare and the Oregon Health Plan (OHP). Medicare covers Duodenal Switch, RNY, and gastric lap band. OHP does not cover any WLS as a matter of policy. OHSU is a Center of Excellence for Medicare and BCBS for PEBB.

Question:

Did they tell you what the guidelines where for the surgery?


BMI
Do you have to have diabetes? Any info would be great!

Medicare covers the following: - BPD/DS aka DS (Biliopancreatic Diversion with Duodenal Switch) (lap and open) - RNY (Roux-en-Y Gastric Bypass) (lap and open) - AGB aka Lap-Band (Adjustable Gastric Banding) (lap only)

Each procedure must be performed in Medicare-approved (as in Center of Excellence) facilities.  For a listing of them, click on this link: http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage

Medicare does not cover the following: - VSG (Vertical Sleeve Gastrectomy) (lap and open) - VBG (Vertical Gastric Banding) - AGB aka Lap-Band (Adjustable Gastric Banding) (open only) - Gastric Balloon - Intestinal Bypass

As for revisions, Medicare covers open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB) and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) if certain criteria are met and the procedure is performed in an approved facility.

Source: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=100.1&ncd_version=2&basket=ncd%3A100%2E1%3A2%3ABariatric+Surgery+for+Treatment+of+Morbid+Obesity Medicare does not pre-authorize any medical services that are considered "medically necessary".  For WLS, "medical necessity" is defined as follows: BMI of 40 WITHOUT any co-morbidities BMI of 35 WITH at least one serious co-morbidity (such as hypertension [high blood pressure], heart disease, diabetes (Type 2), and sleep apnea) Hope this helps!

Hi again,

My goodness, I have been struggling so bad with this. I just recently heard that OHP or Medicare would be covering the gastric bypass or lap band procedure. I know that there are certain guidelines that you have to have to qualify. Where I'm really confused and stressed is do you have to have 1 or all to qualify for this surgery if you have Oregon Health Plan?

Is there a list saying what you have to have, or is there only one or two things that you have to have? Like diabetes OR hypertension?

My doctor thought you had to have EVERYTHING that they list? If you could be of a blessing and help me figure this out, that would be great.

Take a look at my obesity help profile and you can see what I have been through with these doctors!

I checked OHP's prioritized list of health services that was effective April 1, 2008.  WLS is covered under line 33 only when the co-morbidity is Type 2 Diabetes and the BMI is 35 or more.  Those without this co-morbidity are still considered far lower in priority under line 608 of the same list and are therefore not covered under the OHP.  Here is the link: http://www.oregon.gov/OHPPR/HSC/docs/Apr08Plist.pdf According to the OHSU website, OHSU still considers surgery for treatment of obesity as "below the line" for OHP.

So basically just because I don't have Type 2 Diabetes they won't cover me. I have everything else, but that. It so silly anymore. They would deny me right away because I don't have it. Goodness Gracious.
I need a miracle! I have exhausted all my options. With insurance companies, with getting personal financing and or a loan. Why so hard?

Is there anything else that might help me? I saw Doc. Tersigni in Coos-Bay. I paid for my consult. That was the best thing that I have could done. Now, I just see myself getting deeper into a black whole sinking and not coming up!

Here is a list of businesses that help with financing of bariatric surgery:

http://www.medicredit.com/ http://www.p-f-s.com/ http://www.cogentfinancialgroup.com/ http://www.capitalonehealthcarefinance.com/ http://www.citerrafinancial.com/ http://www.mymedicalfinancing.com/ http://www.surgeryloans.com/ Hope this helps!

Thanks for the good tips. I have tried. Unfortunately my credit is not that well. That is why I feel like I have hit a black hole deep down. Why, due to past medical bills due to my situation of being over weight. They just kept piling up and I just got depressed and couldn't do it anymore. I just can't. I have prayed and prayed for a miracle to happen. I was watching GOD TV the revival the other day. Well it is on this whole week about healing, and prayers getting answered. I sent a prayer request in. It is something massive that is happening over the world. I just have to keep faith in that and GOD will provide it for me.

Thanks
Good Luck! Hope all goes well. Not to much longer for you!

Hello My name is Jackie I have been researching and decided I want the baritric surgery. Intially I saw Neal Gorrin when they opened up the Oregon Bariatric Center at Sacred Heart. I have had been denied several times via my insurance with my last employeer. I just recently got approved through OHP Standard...

This is good news.  I live in Eugene, and I had sleeve surgery Oct 2008, but I paid for it myself.  I just gave up on the insurance companies.  I went to Dr. Aceves in Mexicali, Mexico and he was fabulous.  I have lost 105 pounds.  If you have any questions or need any help or answers I am close by.

Take care,

trillium (Oregon health plan)now does cover wls)

 I am going threw the process now and have seen Dr Maccoll at the Oregon bariatric center IN Springfield  Its a coe

 I was told that ohp has covered wls since Jan 2012

 Im hoping to get my sleeve in may 2013

Plastic Surgeon, Michael Bohley at Adventist accepts Tricare, ChampVA, and Social Security. He is an experienced surgeon with bariatric issues and he knows what needs doing.He also goes the extra mile for ALL his patients, regardless of how they pay. His private pay fees are very fair and very reasonable. His office manager, unlike somany, knows how to get these benefit programs to pay, rather than "oops" billing so that it is denied. A breath of fresh air!  If you have had a PS tell you that your not going to be covered-get a second opinion from this team. They are great and will be straight up with you. tee

Where is he located?  I'm in Southern Oregon, and would love to call his office.

Thank you so much. 

 

I am a 61 year old woman who had worked for 45years prior to becoming disabled.  I am now on SSD and my insurance is Medicare and my Medigap insurance is OHP plus. I hope not to bore anyone, but I will give you a run down of my illnesses. 1.Ehler-Danlos Sydrome (connective tissue disorder) 2.Rheumatoid Arthritis 3.Fibromyalgia 4.Sjogrens 5.Sleep Apnea(use a cpap machine) 6.MDD 7.PTSD 8.Osteoporosis 9.Degenerative Disc Disease 10.Osteoarthritis 11.Hypertension 12.BMI 43.9% Medicare covers WLS w/co-morbidities (I have them all diagnosed and in my medical records) OHP plus covers co-pays and requires only two co-morbidities. 1.BMI over 35% 2. Diabetes My sister died of complications due to Type 2 Diabetes, but I do not have that illness, therefore the state of Oregon will not pay the 20% co-pay for WLS. So that means NO surgery, there is no savings with SSD.  I'm not posting this as a whoa is me note. I just want anyone who has these plans to know where they may stand.  God Bless you all, in your efforts to become well.  abl4barb.

Let me see If I understand you. Medicare will cover the surgery. You can't have the surgery because your other insurance won't pay the co-pay. I have medicare and I am seeing Dr. Tersigni.  Lindah55

ok.. im new to this.. im 26 years old 428 lbs and 5'3 im on medicaid and also 37 weeks pregnant .. where and how do i try get a gastric bypass? i just now recently devoloped gestational diabetes but i have good blood pressure.. i dont wanna be a super fat mom or cut my life short from my child so im so serious about tryin to find any information on this procedure any help or knowlegde would be so useful. will i be eligiable? anythin would be soo helpful thanx

Oregon Bariatric Center at Sacred Heart Hospital at Riverbend takes Medicare and Medicade., They are undergoing a staffing change of their surgeon in August. They are a Center of Excellence.

Oregon Bariatric Center at Riverbend is no longer a "Center of Excellence". It is sad that they cannot keep a bariatric surgeon. One must wonder why?  Many insurance companies  including Medicare and  Medicade   will  only pay for weight loss surgery if it performed in a "Center of Excellence". There are currently four "Centers of Excellence" in the state of Oregon: Bay Bariatrics in Coos Bay, St Charles in Bend, OHSU and Good Sam in Portland. You can  go to  The American Society of  Metabolic and Bariatric Surgery's web site to see where the SRC are located and why it is important to go to a bariatric center that has that designation. I hope this helps!