question

pebtash
on 4/2/14 3:37 am
VSG on 11/25/14

 I've been reading a lot about WLS and what I found was if u have a BMI of 40 or more u qualify and under that with a commodity. Does any one know if you are on Medicare and have a 40 or more do u still need a commodity?

KittyKarin
on 4/2/14 3:58 am - FL
VSG on 01/09/13

Hi there!

I find this information regarding what Medicare covers online.  You can also call CMS or a surgeon's office to get information about what the requirements with medicare are. 

"Medicare offers bariatric surgery to beneficiaries with a BMI of 35 or greater and at least one severe weight-related problem (such as diabetes, heart disease or sleep apnea); all other medical treatments for obesity and related conditions must be ruled out. Documented evidence in your medical records of repeated failure to lose weight in medically supervised weight loss programs (diet, exercise programs/counseling or drug therapy) is required. Medicare requires surgery to be performed at a Medicare-approved "Center of Excellence" (including UW Health Medical and Surgical Weight Management Program) and that the specific procedure used is approved by Medicare.

Your out-of-pocket costs will depend on which type of plan you receive your Medicare coverage from:

  • Original Medicare Plan: Medicare covers 80 percent of the approved amount. You are responsible for the remaining amount.
  • MediGap/Medicare Supplemental Plan: Call and ask what is covered by the plan. Many times with MediGap plans, you will pay little or nothing.
  • Medicare Advantage Plan: Call and ask what is covered. The plan must cover at least what Original Medicare does, but it may cover more. "

Hope everything works out for you! 

KittyKarin :-) Starting weight: 362 / Surgery weight: 353 / Current weight: 190 (03/27/2017)

MsBatt
on 4/2/14 3:23 pm

If your BMI is 40 or more, no co-morbidity is required. And they've dropped the requirement that surgery be performed at a Center of Excellence.

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