Has anyone on this Board had Medicare as primary ??

I found out today that starting May 1st that my Medicare will be effect...called the surgeon's office to get the ball rolling (I was with another surgical group and scheduled for RNY as a self-pay when I discovered the DS thanks to this forum) with a center of excellence and the only surgeon that does the DS near me and was told that Medicare does not cover the DS.  I was so confused, so I called Medicare and did not get a straight answer???? . I'm not sure if the person at the WLS center was new, mistaken or dumb????  Can anyone help??? Thank you...I want the DS and if I have to, I will have to borrow money if it is not covered by Medicare

The DS is one of the surgeries on the Medicare approved list.  I have Medicare and my revision from RNY to DS was covered.  Just know up front that Medicare does not pre-approve anything anymore, so you will usually end up having to sign a paper with the surgeon saying that if Medicare will not cover it....you are responsible for the bill.  I also had to pay my co-pays up front to the surgeon and the hospital up front.  Ive gotten my bills for the anesthesiologist, radiologist, and pathology so far...and all have cleared Medicare for payment.  You just have to find a surgeon who accepts Medicare for surgery.  I know Dr. Rabkin in California does not, but there are a number of vetted DS surgeons who do.

You just have to meet certain requirements by Medicare:

1) BMI of above 35
2) At least 1 co-morbidity related to obesity
3) Have been previously unsuccessful with medical treatment for obesity
4) Surgery has to be performed at a Center of Excellence (COE)

The following surgeries are approved:
1) RNY
2) Band
3) DS

Here is a link to the CMS publication addressing bariatric surgery: www.cms.gov/MLNMattersArticles/downloads/MM5013.pdf

Good luck to you and dont take "No" for an answer.  If the DS is what you want, make sure you pick a vetted surgeon to do the job.  It may require travel, but its worth it in the long run.

Medicare paid for my DS.  I did have quite a bit of out of pocket expenses including a surgeon fee, and assistant fee and the nutritionist's fee.  But Medicare paid for the rest.

You have to find a surgeon who TAKES Medicare which is getting harder every day I imagine.  I know finding a pcp and an endo who take Medicare has been hard.

PM me if you have any questions.

~Becky

I don't have Medicare, but I have a friend that does and Medicare paid for her DS. The tough part is finding a DS surgeon who accepts Medicare, and who can do your DS at a "center of excellence". But Medicare very definitely covers the DS, and has for years.

Larra

Medicare paid for mine...without a hitch.

What Medicare does not yet cover is the VSG!! See section 100.1 B

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals /downloads//ncd103c1_part2.pdf

Liz

 I am planning a revision from RNY to DS and I am on Medicare. I checked and Medicare does cover it. You might be able to sign up for Medicaid as a secondary insurance to pay for the co pays. I spoke to DSHS in wa state and they will pay anything that Medicare doesn't cover, including co-pays. You should look into it. My problem is I have such a high spend down. But I suppose even then I am getting a heck of a good deal.  I checked with the insurance specialist at the surgeons office and she tells me that if Medicare is my primary then with Medicaid as a secondary I do not have to follow any of Medicaids requirements, only Medicare. Good Luck

Look at this list: http://www.dsfacts.com/North-American-Duodenal-Switch-Surgeons.html and then start calling to see if any of the closest ones to you take Medicare.

medicare covered my DS without a problem, and Aetna my secondary which refused to cover the doctor due to geographic location also covered it once medicare was primary,  it was very smooth and tricare paid a piece also,   

I wanted to say Thank you for all the information. This forum has been a lifesaver for me. I am an RN, but if not for what I learned here, I would still be ignorant of the exsistance of the DS. I know many of the DS'ers have moved on but I would like for them to know and especially Becky(BeemerBeeper) if not for you taking time out of your life to help others and giving the actual facts about this Surgery that I would only be aware of 3 WLS surgeries and not 4. Thank you from the bottom of my heart.

Carla

Carla, I see you have a surgeon listed in Nashville...if they don't take Medicare (an none did when I was looking) try Dr. Stephen Boyce here in Knoxville...he took my Medicare, did the DS on me even as a lightweight and altho not listed on dsfacts, he is a skilled surgeon. It's his office staff that has the RNY on the brain.

Liz