what does Medicare pay

Sherrie B.
on 8/1/10 7:20 am - Mineola, TX
Good afternoon all,

I am realitively new to the group. I have not been utilizing the forum much but have decided that I am going to get more involved so that I can gain support and knowledge of all those gone before me. I am currently trying to get insurance coverage for a gastric bypass revision that will cost about 15k... I have been told that I can get an insurance that will cover the amount that Medicare will pay. I don't know what Medicare wil pay so I am hoping that someone here will be able to help me out with this. I live in Texas.  Thanks,

on 8/1/10 8:22 am
If you meet medicare's reqs, they pay all but 20% and your deductible. I'm out about 900$ at the moment and that should be it besides anesthesia.
on 8/1/10 8:25 am - OH
They pay 80% of  most stuff, including the surgeon, anesthesiologist, doctor's office visits and many pre-op tests.  I think they pay all of lab work now.  They should pay part of the psych eval, I think they pay 55% of mental health stuff now.

Sherrie B.
on 8/1/10 8:54 am - Mineola, TX
Thanks so much!  I am going to call the insurance carrier tomorrow and hopefully get coverage.  I will be posting my updates as I really do need support. I had a lap band in 2004 and lost 30 pounds over the next two years and that was all. Then my band stopped working and I have gained back what I lost plus much more. I have a lot more riding on this surgery this time as I have a kidney disease and I am trying to avoid having to get dialysis and just go for a transplant but you cannot get one if you are over weight.

on 8/1/10 12:09 pm - Suffern, NY
I am not sure I understand your post, do you have Medicare and you want to get a supplemental plan to pay the difference of what Medicare won't pay - Medicare pays the first 80% and you can get a Medicare supplemental plan to pay the extra 20%.  Is that what you are asking?    Each state has different supplemental plans but I am pretty sure they all have AARP and that is a very good supplemental plan. Another one is Blue Cross Blue Shield - in NY it is Empire Blue Cross blue shield - I am sure in Texas you have the equivalent. If you aren't talking about a medicare supplemental plan, then please explain better.

As far as Medicare goes - they do not preapprove.  You must go to a Center for Excellence and meet certain Qualifications.  I was told you must have a BMI of 40 or above and have atleast 1 comorbidity - many others have been told 40 or more with no comorbities and 35 -40 with comorbities, so you are best to call Medciare and see waht they tell you.  Comorbities are Diabetes, high blood pressure, high cholesterol, sleep apnea, GERD, asthma and osteoarthritis.  You must have a Psych consult and a Nutritional consult. No 6 month diet is required unless your particular surgeon requires it.  You must also get Medical clearance from your PCP with a letter of medical necessity.