Medicare - frustrated!

I went to my seminar last night and now trying to deal with Medicare. Has anyone else out there got any tips, advice, kleenex? I am on medicare andmy spine surgeon says this is a necessity for my back surgery. I am from Salem Indiana but have chosen Norton's as my hospital and hopefully Dr Rodriguez as a surgeon. Any input on how to proceed??????

Has Medicare denied you? Medicare will pay for this surgery as long as it is deemed medically necessary. I don't know if your back problems alone will do it. Do you have any other weight related conditions that would improve if you have WLS? For example, high blood pressure, diabetes, reflux disease, sleep apnea, pain, difficulty walking/moving/exercising. Have you tried other weight loss attemps? You also must go to a hospital that is a Center for Excellence. Check to see if Norton's is one of those facilities. Please provide more details about the problems you are having with Medicare. I may be able to help....

Ok.....after spending 2 1/2 hrson the phone being bumped from rep to rep (males) because they did not know how to answer my questions....here is what I found out. I may or may not have a limit, I may or may not have to pay for part of it, my medicaid is changed but I received no notification (they say it no longer medicaid for low income) and it would be better for mew to get on the website and look through my handbook. I called Medicaid....the rep laughed because all medicaid is for low income and they (medicare) were just trying to push me off on them. She was helpful though and told me that whatever medicare won't pay for...they will. (huge sigh of releif) I was told that since I do have other issues besides my weight....degen.disc disease, joint disease, hypertension, depression, already found to be disabled by Soc Sec.and collecting benefits, sleep apenea, reflux problems...that I should get approved with no problems. I have tried every diet known to mankind since I was 7...I am now 43. Norton's is a center for excellence....thank goodness! My psychologist and spine surgeon both want me to do this and have given me letters indicating it would be the best method for me due to my physical limitations with exercising. I tried to get on the website, but they have to mail me a password and they informed me it would take two weeks for me to receive it. Can you offer any advice?

Medicare will usually pay if just a few things are met. Go to medicare's website and look up all that u can. The surgery must be done at a center of excellence. (thats the only part I am waiting on now, paperwork) If you have a BMI of 40 and up or a BMI of 35 and up with comorbids such as diabetes, sleep apnea, high cholesterol and things like that they will usually cover. You will have to have a letter from you pcp and u can also get letters from any specialists u see to make ur case even better. Medicare does no preapproval process. Some people prefer it but just wondering. Did you know that Dr Rodriguez does open surgery only? No Laparoscopic. Typically you wont have to do anything other then getting some medical records and then going to appts that they send you to. The surgeon's office usually takes care of everything else. Hope I helped a lil.

It does Joy! I already have my med recs and am completing the pamplet they gave me. My spine surgeon has given me two letters for them and I am going to talk to my psychologist Monday about his letter he was to also write. My primary Dr moved to Minnesota, so I have just started up with a new one. He has already balked at the idea of me having the surgery ( he thinks I can lose this on my own if Ireally wanted too....old school thinking from a small town Doc)...would it be ok just to have my original primary physicians medical notes and records? They were what got me my Social Security disability.....they cannot be too bad! No one around here has had this surgery, so I feel like I am up here alone trying to figure all this out!

See if you can get ahold of your original pcp. They knew u the best and longest and most likely will have no trouble writing a letter stating that u would benefit greatly from the surgery and it has come to a point where it is medically necc. Medicare will need a letter from ur pcp so use the other one that would pull for you. You will also need some medical records. How far back I dont know but u will need some to show ur weight, even weight loss attempts the doc documented would be great, and any health troubles that your obesity has caused etc. I meant to say before dont EVER! try calling medicare to ask about this surgery. I learned that after hoursssssss on the phone with them in the beginning of my journey only to get told something differant each time I called! Please feel free to ask me anything. I will try my best to help you. My surgeon already has all my paperwork. I am just waiting for the center of excelence to be finalized (for the ppl to send the paperwork to the hosp) and I will be getting the last couple of my pre/op appts. My psych eval and nut consult are already done. Are you wanting an open incision surgery or laparoscopic? There are other doctor's in Louisville, even others in with Dr Rod. that do laparoscopic too. Best of luck to you. Keep me updated and feel free to message me anytime. Joy

I am on medicare and I am using Norton's downtown with Dr.Allen and I have no trouble at all. Medicare does not make you diet for six months, they have been so easy to work with so far with me. I only had to pay the first hundred for the dietitian and like forty on co pay at Dr.s office. I have no other insurance due to haveing cancer years back because, no one will except me. Medicare also has approved Norton's for this type of surgery with anyone. Are you sure your not thinking medicaid? Good luck. Also I have serious back troubles and the back surgeon wants this done also.

Medicaid informed me they would pay for whatever medicare does not. I wanted to go with Dr Rodriguez, but since he does not do the lap band laproscopically, I am going with Allen (since he was my second choice). I am in the process of trying to track down my old pcp...she is either in Minnesota or Wisconsin...cannot remember which! Anyway....paperwork is ready to go after I see my psych on Monday. That is Dr Majd and him for letters so far! How many letters do I need? Have they given you an idea how long til surgery? What kind are you having? I am 43....

they never ask me for any letters. Could be your family dr. are your back dr could send one if they want it. good luck hope it goes fast for you. I hope to have surgery by the first week of May. I only have two more pre test to do. the wait to hear from the dr. office. I will keep you up dated. I am having lap band dr.Allen thinks that one is best for me. You will like him hes very nice and know what hes doing.