- HEALTH TRACKER
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:
If they accept Medicare and or Medicaid
This list will remain here for our members to access and use.
Thank you so much!!!
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!
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!
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
"Everything that elevates an individual above the herd and intimidates the neighbour is henceforth called evil; and the fair, modest, submissive and conforming mentality, the mediocrity of desires attains moral designations and honors"
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.
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!