Question:
Medicare

Anyone out there in Nebraska had them pay for WLS and how long does it take them to approve Thanks Darlene    — pussycat61 (posted on September 10, 2008)

September 10, 2008
Hi Janie, I know you asked about your state..but I would think Medicare would be the same all over. I know my sister in law had Medicare here in Florida and she had to do a year of Dr. [PCP] followed diet, with several other things to do also. Like have a physic eval, bood work . Once she found out what was required she and her PCP made sure every thing was done and then sent her to a Dr. for the surg. I drove her and in a month she had her surg date. All went well.
   — tootsie52

September 11, 2008
I live in Alabama and have medicare only. Medicare does not preapprove. The dr sends in the paperwork and if the dr says that wls is medically necessary then the dr does the surgery and medicare pays what they will pay minus your 20% of the fees if your deductible is not met or partial if you have state help with the 20%. I had to pay the deductible at the hospital after my surgery and it was 4 yrs and 7 mo ago of $876. My consult was paid by medicare all but $14 and change. My drs visits after my deductible was $64. All other drs that I saw and tests done before wls was small fees, but nothing big over $100. I had to lose 20 lbs as my dr said it would shrink my liver and keep it out the way during surgery. I did not have to do a 6 mo supervised diet. I did have to submit a list of diets that I had ever been on and lost weight with. Which i took upon myself to get documentation from the places that i joined and or places that I used to get help losing like weight watchers...I lost weight with hundreds of diets and would gain all back plus more and I kept a diary of it back yrs which i submitted to my surgeon in copies. Not that he read or looked over them, but non the less I had documentation just in case medicare or my dr asked. I got records from gyms and weight clubs that I had joined and I always kept a chart with them how much I lost and as always the weight came back and more packed on. I had a list of comorbidities and that helped more than anything. Plus the 21 meds that I took. Medicare does not preapprove unless they have changed the last 4 yrs and 7 mos.
   — mspisces