Tennessee Medicare Post-Ops: Input needed

katikati
on 6/21/12 10:25 pm - Eads, TN
VSG on 02/06/13
I finally got a call back from the surgeon's office in response to my application for surgery.  I called Medicare before I ever turned in the application to confirm the qualifications for surgery, and I was told that I needed to have a BMI of of 35 or greater, at least one of the comorbidities listed (diabetes, hypertension, etc.), at had to have the surgery at a COE.  However, when the lady from the surgeon's office called me back, she said that it had to be refractory hypertension with attempted treatment by at least three different medications.  I researched this, and I found that guideline to be true for Medicare surgery applicants in Texas (something to do with approvals going through something called Trailblazer), but I can't find that documented anywhere for Tennessee.  So, Tennessee surgery post-ops, or approval receivers, what was your experience?  Did these very specific requirements apply to you?

    

rhearob
on 6/22/12 5:52 am - TN
 Did medicare provide you anything in writing - if so provide that to the surgeons office.  Otherwise, I would call medicare back and ask them to fax something to the surgeons office.  It could simply be that the surgeon has outdated info on file.  It happens.

_____________________________________________________________________
 160 lbs lost. Surgeons Goal Reached in 33 weeks.  My Goal in 37 Weeks.

VSG: 11/2/2011; LBL+Thigh Lift+BL: 10/3/2012; Brach+Mastopexy:  7/22/2013

katikati
on 6/23/12 12:04 pm - Eads, TN
VSG on 02/06/13
Just want to follow this up in case anyone else runs into this same problem.  I called Medicare back to ask about this specifically, and the person I spoke to was incredibly helpful.  She checked all the documentation she could and said she did not see anywhere that it was specifically required for one to have refractory hypertension with a history of having tried at least three medications.  You just need the comorbidity of diabetes, hypertension, etc.  I'm going to print the information from the CMS web site and fax it to my patient advocate at the doctor's office on Monday to clear this up.

    

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