What to do first?

Hello I am new here. I live in Powhatan Va,  I have many medical issues and Fibromyalgia, I just know I wouldn't be in as much pain if I weren't so over weight.  100 lbs or more.

On an average day , the most I do is clean some with sitting in between, I only leave my house for a doctor app. I go to the store once a month.

So I just get fatter by the minute.  I feel as if I am just waiting to die.

But I don't know where to start... I have been approved for SSD.  I have Medicare but not Medicaid. My part B doesn't kick in till July. I don't even know or understand how the Medicare works yet. I assume I have to wait till July before going to see a doctor. What if I go see a doctor and it doesn't pay for the visit? We don't have a lot of money. I just don't know what to do next.  I don't even know which doctor to see. Can someone please advise me? What is the first step? Does Medicare pay for this? I do have sleep apnea. ( sleep with a machine) I have hypothyroidism, acid reflux, high cholesterol ...which I take pills for... So I think I would be eligible for this. but does Medicare pay? Do I wait till July when the part b kicks in? What is the first thing I should do? Thanks in advance for any help.

Hi There...... Ok...first things first.....WELCOME! I have not used Medicare, so I won;t be of much help.  But, have you looked into visiting with a Bariatric surgeon who accepts your insurance?  They often times have free seminars you can attend and have people there who can help you with the insurance questions.  Or, at the very least, you can call them. Have you talked to your normal doctor yet about this?  You may need a referral from them to actually see a Bariatric surgeon (unless you go to the free seminar). That's all that I've got.  I know that they cover the procedure, because there are several here who used Medicare to pay for it.  So, you should be fine with getting approval.  I just do not know what the process is. I wish you the best of luck!

Thank you for the reply, I thought it would probably take a while to get an appointment so I thought I would start making calls on Monday. I can't see my pcp till July because I wont have part B till then. I may have to just wait till July to start this process. But I will learn all I can from this board before going to the doctor. Thanks for the welcome as well

Welcome to the Virginia Board - I am not going to be much help to you either ,sadly, as I don't know about medicare or medicaid except that they do often cover this procedure. I think what Jill said is correct about finding a doctor who does a free seminar and often they know about the insurances and can give you help..... Don't give up - there is life after obesity! You just have to make the first step to get started. Search on the internet for information and doctors and make calls to find out more. No-one started this journey knowing everything. Also call the isurance company and ask what they do to cover it and what the steps would be to get approval........  then you will at least have the answer to that part of your question..... Good luck and keep us informed of how you do.. Jackie

IAs Jill said...  Welcome to our board.  This is a great place to meet friends and get information, ask questions and find answers.  Maybe I can help you as I am a Medicare (& Medicaid) Recipient.  Medicare Part A is the hospital insurance and Part B is basic medical coverage for like dr visits and such.  I am thinking that maybe you will have to wait until the part B kicks in to have the visit covered.  Don't panic.  There are TONS of doctors out there that take Medicare.  The practice I am going through is Commonwealth Surgeons and they are located in the west end of Richmond.  Actually they have an office at St Mary's Hospital.  My surgeon is Dr Bautista and I completely adore this man and trust him completely with my life.  The good news for you is that they take both Medicaid & Medicare.   There are a few requirements for the surgery that Medicare makes you to.  I had to do a 6 consecutive weight check & monitored diet with my primary care doctor.  I had to see a nutrionist, which wasn't a big deal since I am a diabetic and my endocrinologist has one in his practice.  I had to get a psych evaluation and releases from the specialists that I saw, heart. lung & diabetic dr.  But I don't think that their requirements are much different from any other insurance out ther.  The only big difference is that Medicare DOES NOT do a pre authorization.  They require you to do all their requirements, then they ask you to sign an ABN, which is an advance beneficiary notivce.  That is a paper stating that you know Medicare has not agreed to pay for the surgery yet, and that they may not cover it  and if they don't that you will be financically responsible for the cost.  Then you do the rest of what the surgeon wants, get your date & have the surgery & then the surgeon's office submits to Medicare for payment.   That is where I am.  My surgery is this Wednesday.  I don't know if it is covered or not but at this point I don't care.  With out it I will die.  I think it is a fair trade off.  I thoroughly recommend Commonwealth Surgeons as I am sure alot of others on here will too.  If you want to PM me, I will be happy to give you the information from their office.  I know it seems like a lot to do but time truly does fly.  I hope I have been helpful and not bored you to death.  If you have questions please feel free to message me.   Hugs

Thank you for your help.

My Goodness what happens if they(medicare) bail out and don't pay after the surgery is done?

That would be my fear.

I do understand even if they do pay their part, Since I don't have medicaid that I will have at least $1000 to pay out.

but we couldn't afford to pay out of pocket for the surgery. As hard as it is for me to leave my house, I think I will go to one of the seminars. You have been most helpful and thank you Oh and good luck to you on wed.  Please let me know how it goes.

You are very welcome.  Also, 1 thing I did forget to mention is that when do make an appointment with the surgeon, for the first visit, they do require that you see the dr and not a nurse practioner.  Which is good, the dr can then tell you everything that needs to be done or if you have started doing things, what else you have to be done.  Dr Bautista told me that that is so you have all of Medicare's requirements so they have less reason to deny you.  If they do deny you, you do have the right to appeal.  As Jackie mentioned, going to a free seminar is great.  My surgeons office offers 1, as do many.  Have faith that Medicare will pull through.  Again, if you have more questions, feel free to contact me. Hugs

Thank you and I do have so many questions.. Like what are the requirements also I have read that some have to do a pre diet...crapola if I could do that I would have already lol anyways I will start with app. I will call tomorrow.. I need to choose a real nice dr...lol thanks Darla

Hey Darla Are you asking what are the requirements for Medicare?  The bariatric coordinator at a surgeons office can better tell you but as far as I kmow they are as follow:  a 6 month consectutive weight check and monitored diet by your pcp, an appointment with a nutritionist and a psychiatric evaluation.  Your surgeon may require different things.  Mine gave me a full day of pre op tests, x-rays, ekg, blood work and blood gas tests.  He also required a 4 hr class that included a behavior class and a diet class.  All that was on the same day, from 8 am until 8 pm.  It was a long day but at least I didn't have to make several trips.  And I am assuming that you are referring to a pre op diet?  With my surgeon, yes he required it.  It usually starts 2 weeks before surgery.I think alot of surgeons require it if you are having the procedure done laprascopically as opposed to open.  It isn't that bad.  I had 2 shakes a day, (carnation instant breakfast) and a low carb high protein meal.  After a few days, it gets better.  There are a lot of people on this board so alot of doctors to choose from.  But of course, I do recommend mine, lol. Any more questions, please feel free!! Hugs

Hello and welcome!!!! I have primary insurance thru my husband and Medicare ( part A only ) I plan on using my primary insurance for my surgery but I can tell you that medicare will usually pay as long as it is medically necessary and it MUST be done in a hospital that they feel is a center of excellence. The approval process is totally different. Everything is submitted after surgery for payment. You may also want to check the deductable. My Medicare deductable is about $1028.00. Don't want to be negative just informative. Please call Medicare or visit www.medicare.gov and gather as much information as you can beforehand. That way you will not have any unpleasant surprises after your surgery. Again this is not meant to come across as negative or discouraging, I am just trying to be helpful.  Good luck, Becky