Medicare

My brother has Medicare parts A & B.  Does anyone know what they require for WLS?  He is confused and can't seem to get a straight answer.  He wants to know exactly what he needs to get the process started. Thanks in advance for any advice!

When I had my surgery in July of 2005, medicare only required that my bmi be greater than 35 and have at least one comorbidity.  They covered my ds with the exception of my inpatient co-pay.

Hi, Right now i am working with Medicare via Humana.  And here is what they require right now. Over 18 years old Have a BMI 35-40 w/ co-morbidities if over 40 no co-morbidities needed. Psych Eval Nutritionist Eval Must be done at a "Center fo Excellence"   Hope this helps. Michele

Michele, Thank you for your reply.  Do you know if they require a 6 month supervised diet?  I've read in some places that they do, in other places they don't. Thanks again! Denise

Denise, I believe the answer is NO.. altho Humana did require me to do 6 months.supervised weight loss. Here is a link to a pdf file my mom sent me yesterday. I does have some info on Medicare and Bariartic surgery. If your going straight through Medicare and not an insurance company providing a medicare advantage policy i would call Medicare directly to double check. http://docnews.diabetesjournals.org/cgi/reprint/3/5/7.pdf The most important thing i have figured out is the "center of excellence" double check to make sure your surgeon is in a center or excellence.  they might be accept medicare but if it is not a center of excellence medicare won't pay. you can go to   http://www.asbs.org/html/about/membersearch2.html and search in your area. Hope that helps..       

Medicare does not require a six month supervised diet. The only big thing with them is the hospital must be a Center of Excellence or they won't pay. I am having surgery in one month and I have to go to Oklahoma because that is the closest Center of Excellence to me. I did have to pay out of pocket for my nutritionist visit because Medicare would not pay for that.  Steph :wave:

I read your post about medicare & the 6 month diet not being needed where did you get this info so I can show my surgeon in writing ? Thanks for any help. You wrote :Have a BMI 35-40 w/ co-morbidities if over 40 no co-morbidities needed. I have a BMI over 40 so I am very interested in this. Thanks again, Kelley

Hi Kelley, Humana will not give you anything in writing. ;o)  check your box and i will send you a PM w/ who and what extention i spok w/.. Good luck Michele

I'll be looking for that pm :) Thanks :)  Imagine that ! Nothing in writing ! Figures !!