I have a question

Cathy5722
on 12/8/08 12:15 pm - owensboro, KY

I have medicare and medicaid, and have done the weightloss program for 6 months with my doc, now they are telling me since I did this in 2007 and my surgery would be in 2009, I have to do the weight loss 6 month program again, cause medicaid requires it to be the year before your surgery. Even though medicare is my primary Ins.

Has anyone ran across this problem or has any suggestion about this...also anyone else had the surgery with medicare and medicaid as their INS....

jlph62
on 12/8/08 2:11 pm - Olympia, WA

RNY on 02/01/10

Hi
I also have medicare and medicaid. Since medicare is my primary insurance I only had to fulfill the medicare requirements which are not that hard. Medicaid only picks up the copays. I was approved within a week and have only had to wait because I needed to have surgery at a center of excellence and my surgeon moved to a new hospital. I picked a new surgeon and my date is Feb 9th.

Joanne

First Surgery Consult 449
Surgery Day 404
Current Weight 270......Goal Weight ???

Cathy5722
on 12/8/08 7:38 pm - owensboro, KY

DS on 07/01/10

So isn't medicare the same from state to state? and the same requirements?

May I ask what all you had to do for Medicare to okay you ?

Thanks

Tammy S.
on 12/9/08 6:54 am - Hobbs, NM

RNY on 01/23/11

I too am medicaid and I was told the only requirement for me was to have a psych eval. I went to the first half of that appointment this morning and will go the actual evaluation on Thursday...once that is done, they will send it to my insurance for approval.

I can do all things through Christ who strengthens me. I'm not FAT...I'm JUST fluffy!

jlph62
on 12/9/08 8:43 am - Olympia, WA

RNY on 02/01/10

Medicare is the same all over the U.S. but medicaid can be different from state to state. Here is the ruling from 2/21/06.

The Centers for Medicare and Medicaid Services (CMS) issuedits long-awaited national coverage policy for bariatric surgeryon February 21. The new policy extends bariatric surgery benefitsto all Medicare recipients.

Previously, Medicare covered gastric bypass surgery only ifthe procedure was intended to correct an illness caused or aggravatedby obesity (DOC News, January 2005). Coverage for the operationvaried from state to state in the absence of a national coveragepolicy.

Under the new policy, CMS covers open and laparoscopic Roux-en-Ygastric bypass, laparoscopic adjustable gastric banding, andopen and laparoscopic biliopancreatic diversion with duodenalswitch. CMS will not require that candidates for bariatric surgeryfirst attempt a dietary weight-loss program, as almost all surgerypatients have made numerous weight-reduction attempts.

Bariatric surgery is available for any Medicare beneficiarywith a body mass index $≥$ 35 with at least one comorbidity relatedto obesity.

Coverage is provided only if the bariatric surgery is performedat a medical center designated a Center of Excellence by theAmerican Society for Bariatric Surgery (ASBS) or certified aLevel 1 Bariatric Surgery Center by the American College ofSurgeons. As of February 28, 2006, there were 117 Centers ofExcellence in 32 states. ASBS expects that number to nearlydouble within the next few months.
Hope this helps you out.
Joanne

Joanne

First Surgery Consult 449
Surgery Day 404
Current Weight 270......Goal Weight ???

MommaHen
on 12/9/08 9:43 pm - Oklahoma City, OK

RNY on 11/10/08

I too was medicare/medicaid and my only requirement was to lose 20 pounds that they required before surgery time. Medicaid was a pain and I did there stuff 2 times before getting my medicare only to be denied both times on a similar technicallity. have your doctor try and get prior authorization from MEDICARE as it is your primary. this is something my doctor does on all patients and you will know exactly what they require. I had my seminar (gave them all insurance info then) on a Wednesday night and had my approval by noon on Friday.

Having the time of my life!

jlph62
on 12/10/08 2:38 am - Olympia, WA

RNY on 02/01/10

I too had to lose 5-10% body weight. This was my doctors requirement not medicares. My primary submitted all info and I too was approved in less than a week. I live in Washington state and did not have to do any of medicaid requirements; only my doctors.

Joanne

First Surgery Consult 449
Surgery Day 404
Current Weight 270......Goal Weight ???

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