Need help with Medicare Insurance

I have medicare and they cover weight loss surgery and have no 6 month supervised weight loss diet. But the company that administers medicare for the state of Kentucky on my last medicare summary notice , was CGS and they require the 6 months supervised diet. But today i got another medicare summary notice and the administrator is National Government Services. I thought maybe this new paper was for part A or something but no. They are both for Part B services, in which i was told Bariatric is covered under. But the thing is i cant find anything about requirements on their website. Can someone please help me out!!!!

I would suggest that you call your local Medicare Intermediary and speak to Customer Service. 

When you get your answer, ask them to either send it to you in writing, or direct you to EXACTLY where they got the information they gave you.

Good luck!!! 

 My Dr dealt with all that for me. They accepted without any approval and no 6 month wait. I also have a secondary ins which picked up the remaining 20% so there were no remaining bills. I was very lucky that I was able to have my surgery without any hassle at all.

CGS and National Government Services are Fiscal Intermediaries,  now known as MACs.  They are like a third party adminastrator.  If you have a Medicare covered service they process and pay the claim.  They do not make up the rules such as whether you need a 6 month diet.  If Medicare does not require one then you don't need one. Part A services are inpatient hosptial stay.  Your surgery and hospital stay will be covered under Part A.  So you will have the inpatient deductible to cover.  Tests done prior to surgery such as an endoscopy, EKG, sleep study, psych consult will be done as outpatient services (Part B) for which you will have the deductible if not already met and a co-pay.   Are you sure it isn't your surgeon that requires a diet. 

You would think they would follow the same rules as Medicare but apparently they don't.

http://www.cgsmedicare.com/partb/pubs/news/2007/0207/cope5297.html

The documentation must show:

1. The surgery is medically appropriate for the patient and

2. The patient meets the definition of morbid obesity which is defined as a body mass index (BMI) of 35 kg or greater and

3. The surgery is an integral and necessary part of the management for a patient with at least one of the following life-threatening or disabling co-morbid conditions:

1. Poorly controlled Type 1 or 2 diabetes mellitus
2. Poorly controlled dyslipidema
3. Poorly controlled hypertension
4. Severe cardiopulmonary disease (e.g. coronary disease, CHF, asthma, COPD, pulmonary hypertension)
5. Obstructive sleep apnea
6. Severe arthropathy of weight bearing joints
7. Pseudotumor cerebri

and

4. There is documented evidence of compliance with and repeated failure of multiple attempts, at least three (3), to lose weight on a supervised non-surgical management weight loss program (e.g. diet, exercise, or drugs). It is expected that at least one of the weight loss attempts would consist of compliance with a physician directed program for at least a consecutive six month period without significant gaps. Monthly documentation of the beneficiary's compliance should include:

1. Vital signs to include weight
2. Current dietary program
3. Physical activity/exercise program
4. Behavioral interventions
5. May include consideration of/use of pharmacotherapy with FDA approved medication, if appropriate.

and

5. Psychological evaluation and counseling associated with the lifestyle changes associated with the surgery have been performed prior to the surgery and

6. Treatable metabolic causes for obesity (e.g. adrenal, pituitary, or thyroid disorders) have been ruled out or if present have been maximally clinically treated if present and

7. The surgery was performed in a CMS approved facility for bariatric surgery.

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Thanks LadyTazz!!

I wonder if their is a time length from when i was on the last suporvised diet. Maybe within the last 1 or so. I have been on diet for the last 10 it seems

I was told by my surgeon that Medicare itself doesn;t require any 6 month diet but it is up to the surgeon.  I didnt' need anything and my Medicare papers all CMS.