pre-op requirements

Leslie Stout
on 7/19/12 6:06 pm - IA

Am kind of surprised that I will have all my preop requirements done by 8/2/12 and then will just wait for Medicare/Medicaid approval so we can schedule surgery. Anyone know the average wait for Medicare/Medicaid approval?

nikeah01
on 7/19/12 6:18 pm - AL

took a few weeks and dont be suprised if they deny it the first time but they will send it back with the things they want.

Leslie Stout
on 7/19/12 7:00 pm - IA

Thanks for the encouraging words. I was so excited to be able to get all this scheduled so quickly. I was just reading through some of the posts, and boy, am I having second thoughts, I'm not reading anything positive tonight. sigh I haven't even started yet!!

nikeah01
on 7/19/12 7:04 pm - AL

Well my mood changes daily one minute I am so happy I had it done and other days I am like what have I done to myself but it gets better everyday I am 3 weeks out tomorrow and I would say the worst is behind me now. I wish I would have taken the surgery part more serious I just assumed it would be a piece of cake oh how I was wrong. I can tell you at 3 weeks out I have lost 30 pounds so just keep that in mind!!!!!

Leslie Stout
on 7/19/12 7:41 pm - IA

Have you had any problem in getting fluids and protein down and keeping it down? Have you started on pureed yet? Any hair loss? My surgeon told me that if I was able to take care of myself before surgery, I could care for myself after surgery. There would be discomfort, but I wouldn't have to have any help at home (I live alone). My sister-in-law had this done several years ago and had an open surgery and she said to be prepared for home help for up to 6 weeks. With mine going to be laparoscopic I figured it would be a little easier. But sounds like I better prepare for it to be a little harder and if its easier.....icing on the cake! Thanks for giving me your two cents worth!

nikeah01
on 7/19/12 7:47 pm - AL

I get all of my fluids in just fine and I am working up to my proteins. the only problem I have is if I eat something too dry and trust me you will know because it comes back up. I am on soft foods more or less. for the first few days I needed help getting up off the coach but around day 7 I was getting up and down on my own. My best advice for you is to sleep in a recliner it will make life a lot easier.

poet_kelly
on 7/19/12 7:24 pm - OH

RNY on 11/04/08 with

Medicare does not preapprove WLS. You just have surgery, the doc and hospital submit the bill, and if you meet the requirements, they pay it. So there is no wait time for Medicare.

I don't know about Medicaid, that may vary from state to state. I'm in Ohio and I did not need to get pre approval from Medicaid, either.

Kelly

Disclaimer: I am not a doctor and do not play one on TV. I've done a lot of research on vitamins but am not qualified to give medical advice. I'm happy to share my research with you, but you should see a health care professional if you want medical advice.

Check out my blog at: storyofmyservicedog.blogspot.com/

Leslie Stout
on 7/19/12 7:36 pm - IA

The surgeon told me that he would have to have Medicare approval. I don't know. Medicaid in Iowa will follow Medicare in whatever they decide. Maybe because I'm in Iowa, but my surgery will be in Nebraska.....??? I have no idea....maybe he doesn't really know. I'll talk to the insurance gal and see what she has to say. They're gurus when it comes to that sort of stuff. Thanks for taking the time to answer.

nikeah01
on 7/19/12 7:43 pm - AL

no I had mine done under medicaid and I had to have it approved even have the approval letter from medicaid

Leslie Stout
on 7/19/12 8:26 pm - IA

The drs office told me that Medicaid would follow whatever Medicare did....so I guess I just need to know whether I need Medicare pre-approval. Drs office says yes; Kelly (above) says no, so I'll have to recheck with the insurance gals!

nikeah01
on 7/19/12 8:29 pm - AL

I had it under medicaid and I had to have medicaid approval first after they approved it my surgery was scheduled

poet_kelly
on 7/20/12 2:06 am - OH

RNY on 11/04/08 with

Here is some information from the Consumer Guide to Bariatric Surgery (this info is two years old but I'm pretty sure it's still accurate).

"Many private insurers require a letter of medical necessity from a doctor before they agree to pay for weight loss surgery. Medicare, however, does not require such pre-certification or pre-authorization. A surgeon will submit the claim to Medicare after he or she has performed the surgery on a candidate who has met all the Medicare requirements for weight loss surgery. Some surgeons may ask Medicare patients to sign a contract stating that they will pay for any costs that Medicare does not cover after it processes the claim."

www.yourbariatricsurgeryguide.com/insurance/

Now, this is if you have traditional mediare, Parts A and B. If you have an Advantage Plan, Part C, you may need pre approval.

Kelly

Disclaimer: I am not a doctor and do not play one on TV. I've done a lot of research on vitamins but am not qualified to give medical advice. I'm happy to share my research with you, but you should see a health care professional if you want medical advice.

Check out my blog at: storyofmyservicedog.blogspot.com/

poet_kelly
on 7/19/12 11:00 pm - OH

RNY on 11/04/08 with

Medicaid and Mediare are two very different programs. Medicaid may require approval in some states. Medicare does not.

Kelly

Disclaimer: I am not a doctor and do not play one on TV. I've done a lot of research on vitamins but am not qualified to give medical advice. I'm happy to share my research with you, but you should see a health care professional if you want medical advice.

Check out my blog at: storyofmyservicedog.blogspot.com/

trishv27
on 7/19/12 9:57 pm - MI

RNY on 09/26/12 with

I'm in Michigan and I don't have to have Pre approval from medicare. Medicaid on the other hand Medicaid tells me they follow Medicares guidlines but My Doctors office says they don't.

littleskie
on 7/20/12 6:49 am - freeport, TX

RNY on 08/19/09 with

I'm in Texas and had medicaid and medicare. One I med the requirements it was easy. Quick too. I had to meet the six months weight loss and Show that I had effort in doing so. That was easy. I followed my surgeons plan and still was super morbidly obese.

I got the surgery August 19th and have had a few problems since then but I'd still take the surgery over anything. I could never had done this on my own.

I have been scared and amazed at how much I have gone thru. I have survived so much. I feel Like I can take on the whole world I am so glad I managed to have the usrery or my life would have been worth less.

Met my first goal, met my second goal, met my surgeons goal. Now I have a new goal!

crw4bama
on 7/20/12 7:36 am - stevenson, AL

RNY on 06/13/12 with

I am in Alabama and had mine done under Medicaid and had my approval 3 weeks after submission. Good luck i am now 5 weeks out and it is the best thing I could have everdone I was 30 lbs less after 3 weeks.
Christy

deactivated member
on 7/20/12 8:17 am - WA

Medicaid does indeed just follow Medicare requirements. Medicare does not pre approve they just pay it if you meet thier requirements. They will not allow a Medicare patient to be charged in advance either. I got my first appt and then 1 1/2 months later I got the surgery. I was offered it one month later but choose to wait the extra 2 weeks. It should be just a matter of scheduling the surgery after your pre op test results come in. I am just wondering if your doctor is waiting for an approval because you are using Medicaid in one state to pay for surgery performed in another state? In my state Medicaid is only good in state.

Leslie Stout
on 7/20/12 9:33 am - IA

Thanks for all the replies. I think probably my Dr is making sure that they will pay so I don't get stuck with any cost. He told me get all the requirements done, then approval by Medicare (maybe that means that I'm just totally within their guidelines?) and Medicaid follows suit behind Medicare. Medicaid by itself has its own requirements, but if Medicare is primary, it will follow Medicare.

poet_kelly
on 7/20/12 12:46 pm - OH

RNY on 11/04/08 with

All he has to do to make sure he gets paid is to make sure you meet the Medicare guidelines and then submit the bill. It's up to him to determine that you meet the guidelines though. Medicare won't promise in advance to pay.

Kelly

Disclaimer: I am not a doctor and do not play one on TV. I've done a lot of research on vitamins but am not qualified to give medical advice. I'm happy to share my research with you, but you should see a health care professional if you want medical advice.

Check out my blog at: storyofmyservicedog.blogspot.com/

Leslie Stout
on 7/20/12 1:47 pm - IA

Ok, I understand what you're saying Kelly. So he's just waiting to see the results from my tests to make sure that I will qualify, not actually sending it to Medicare per se'. Question......not sure if you will know this or not, but if Medicare for some odd reason denied it and Medicaid normally follows suit to Medicare, I'd be really screwed wouldn't I? EEK No biggy, not having my requirements/results, my Dr acted and as much as said that with my history, etc, mine would basically be rubber stamped. So it doesn't sound like he's too concerned about them paying for it.

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pre-op requirements