Medicare Guidelines Help

Wendsday1
on 12/7/17 11:18 am

Hi.. I'm Wendy.. I'm new here! I'm on the road to having surgery hopefully in February. The coordinator that I have keeps telling me different things when it comes to Medicare guidelines.. First it was you have to have so many visits from dieticians then she sent me some information and on there it doesn't state a required amount. She's not very friendly however she is the only one there! Anyways, has anyone had to deal with Medicare guidelines? Any info you can provide helps! I shoul say I'm trying to speed up the process as I have gastroparesis in which my food doesn't empty properly to my small intestine making me really sick.. Again, I would appreciate any help! I live in Minnesota! Thank You!

HW 242lbs. CW 209lbs. GW 125lbs.

emt_swva
on 12/7/17 12:10 pm

I have Medicare I had to do 6 months of visits with my primary dr and dietician. And if you miss a month you have to start over again.

Wendsday1
on 12/7/17 12:38 pm

Thanks for your help! I'm being told I need 3 visits and 6 six cumulative visits with primary about weight, etc. I've seen my primary dr over 6 times as I was using phentermine and had to be monitored.. I'm just confused as to what they say and what I've been told by Medicare.. I have Medicare Advantage which basically Medicare is my primary and BCBS picks up the rest.. Anyways, Medicare says the only thing that is required for them is having a BMI of 35> and one comorbid disease.. They told me that they don't need any of the other stuff that is being required for them to pay for surgery.. That's where I'm so confused! They tell me one thing and my coordinator tells me something else.. So frustrating!

hollykim
on 12/7/17 3:10 pm - Nashville, TN
Revision on 03/18/15
On December 7, 2017 at 8:38 PM Pacific Time, Wendsday1 wrote:

Thanks for your help! I'm being told I need 3 visits and 6 six cumulative visits with primary about weight, etc. I've seen my primary dr over 6 times as I was using phentermine and had to be monitored.. I'm just confused as to what they say and what I've been told by Medicare.. I have Medicare Advantage which basically Medicare is my primary and BCBS picks up the rest.. Anyways, Medicare says the only thing that is required for them is having a BMI of 35> and one comorbid disease.. They told me that they don't need any of the other stuff that is being required for them to pay for surgery.. That's where I'm so confused! They tell me one thing and my coordinator tells me something else.. So frustrating!

Medicare might not have any other requirements other than a BMI over 35 and one comorbidity BUT,your SURGEoN might have his/her own additional requirements.

Pit is legal for the surgeon group to add their own requirements on to those Medicare has.

You can switch surgeons if you don't like his additional requirements to someone who doesn't have any additional requirements.

 


          

 

Wendsday1
on 12/7/17 8:11 pm

Thanks for your input! The coordinator says that it's Medicare not the clinic so I don't know!

Valapp
on 12/8/17 2:42 pm
with

I don't live in Minnesota, but I did use Medicare for my band removal and revision to RNY. I didn't have to have anything except one NUT class and psych evaluation and that was required by the surgeon. Go to Medicare.gov and type in weight loss surgery. You can see what Medicare requires. Print it out and take it to your doctor. Good luck!

HW 280

CW 168

Goal 165

Wendsday1
on 12/8/17 3:09 pm

Thank You! I'm a RN so I know how Medicare and other Insurances prior authorize procedures.. I know for a fact I don't have to do all that is this coordinator is telling me and it isn't the clinic requiring it either.. I really feel this coordinator doesn't know what she's talking about! She's really rude and is very hard to get ahold of! I just want to find all information I can! I'm wanting my surgery sooner as I have a condition that my stomach doesn't empty my foods properly making me sick all the time and she doesn't get it!

HW 242lbs. CW 209lbs. GW 125lbs.

NYMom222
on 12/9/17 9:43 am
RNY on 07/23/14

As I still converse with my Surgeon's wife who is also part of the Bariatric medical team and she has been telling me Medicare has been getting very picky lately. They had someone denied with a 62 BMI who didn't have the recognized co-morbidities of diabetes, sleep apnea or high blood pressure....she had other things but not those.

I would contact Medicare and ask for their written policy. Proceed from there.

Cynthia 5'11" RNY 7/23/2014

Maintaining a 220lb Weight Loss
Plastic Surgery Dr. Joseph Michaels - LBL and Hernia Repair 2/29/16, Arm Lift, BL, 5/2/16, Leg Lift 7/25/16

Need to get back to Basics? The Five Day Meat Test

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Wendsday1
on 12/9/17 10:49 am

Thanks for your help.. I'm trying to make sure I have everything covered.

Kathy8429
on 12/10/17 10:17 am

Hello. I am a nurse and work for the Medicare dept. if you're having surgery for gastroparesis the criteria you need to meet would be different then

RNY for weight loss. It sounds like you need to talk with the surgeon to clarify

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