Medicare Guidelines Help

Thank You for your advice! I'm also a RN so I know some about preauths and Medicare just not when it comes to RNY.The RNY surgery I'm having is still being done for weight loss.. I'm just trying to speed up the process cause of the gastroparesis that makes me feel sick all the time.. I'm not even eating everyday anymore. Do you know for sure that there are a required number of nutrition/dietician that have to be done according to Medicare? That's what is delaying my surgery by having to have so many appointments and so far apart cause I have to record what I'm eating for three months.. That just doesn't seem right to me.. I've read that only one consultation with them is enough.. Can you share any other information you would have? I'm so tired of being sick!

Thank You!

It would depend on if you have straight Medicare or a managed Medicare plan like AARP. You can look up on the internet the NCD for bariatric surgery on ccms.gov and see exactly what the criteria is. You can also search for an LCD by state to see if Minnesota has an lcd.

Hope that helps

kathy

I have Medicare Advantage through BCBS.. I don't always know exactly how it works! I've looked online for the criteria and all I ever find is that I need to have a BMI of >35 and a co-morbid disease..That's all they tell me when I call so I'm so confused! What is NCD and LCD..Sorry not sure what abbreviations are just yet on here.. I Really Appreciate Your Help!

Medicare Advantage through BCBS is completely different than straight Medicare. It sounds as if your surgery coordinator is either confused or your surgeon's office has additional rules.

I had to send the criteria for my insurance to my surgeon's coordinator. She was completely unaware of what was needed.

That's what I've been thinking this whole time! This coordinator sent me a sheet about Medicare guidelines and as soon as I read it I called her..There was nothing on there about having to do so many dietitian visits and when I pointed that out to her she got angry with me saying that she's not going to give me a surgery date cause if it gets canceled for any reason then someone else could have had that date..She was so rude! I have everything scheduled as far as the recommendations for surgery and she still won't even schedule a preop appointment with the surgeon..I'm at a loss as to who I can even talk to about all this! With the coverage that I have, do you know exactly what is required for surgery? If you have any information that I can show this coordinator, please let me know! I Really Appreciate Your Help! I just want so bad to feel better and having this surgery as soon as I can is what I need to feel better! Thank You!