For seeking1 (Medicare/medicad and WLS)

Hello Liz, Major mom pointed me to you, i hope thats ok. I have a few questions.I am from indiana. My mother has had the DS. I am a light weight of a BMI of 35. I have medicare and medicaid and was wondering if you knew the ins and outs of the process.

Okay, I don't know anything about medicaid but I did and do use medicare. It was my primary (and only) insurance during the WLS. I did have another insurance as my secondary but they did not pay for ANY of my WLS.

I had BCBSTN as my medicare advantage policy. It followed the medicare rules for bariatric surgery. To qualify, my BMI had to be 35 WITH comorbids or 40 without.

Medicare covers all four surgeries, it added the VSG on 27 June 2012: www.cms.gov/medicare-coverage-database/details/nca-decision- memo.aspx

You will most likely have to use a surgeon IN your state. Be prepared to fight for a DS surgeon if you do not have one who will do lightweights AND who accepts your medical in your state. I had to call/contact EVERY bariatric surgeon IN TN...was on my last option when I finally found one who did the DS (altho not on DSFacts and will never be due to his promoting his own line of vitamins) AND was willing to do one on a lightweight AND was willing to take medicare. (Most do not take medicaid).

You HAVE to use a COE to have the surgery covered...

You don't actually get pre-approval on Medicare...they do all the tests to see if you qualify according to the surgeon, then AFTER surgery, they submit it all to Medicare and as long as you dotted all the i's and crossed all the t's, Medicare will probably pay. NO guarantee of that tho.

IF you have a medicare advantage policy, you DO get pre-approval and payment is pretty much a given then. (Unless it gets coded screwy).

The one thing I discovered is while my approval was quick, getting on the schedule took longer than if I had other insurance or self pay. It's like those of us with Medicare get put at the bottom of the pile.

Any other questions, let me know..

If others have Medicare/Medicaid, please add your experience.

Liz

Thank you so much for your answer! I do have a surgeon in mind and she does take Medicare and is only an hour away. I have another question. Did you get a longer channel then 100 cc. Did you loose the weight really quick? I am worried since i am a light weight they I will shriek down to looking like a skeleton.

I WISH I had shrunk down to like a skeleton...bounce back weight wouldn't be such a ***** then.

I have a common channel of 175, my dh, who is also a lightweight DS'er has one of 125. (he had a different surgeon and a slightly higher starting BMI)

I weighed 203 when I checked in with my surgeon, for a BMI of 35.2. I was told NOT to lose any weight...still weighed 199 on day of surgery. And the ONLY time I didn't eat was the last 12 hours prior to surgery.

I weigh 130 now. Did get down to 121 before heading back up.

06/16/2010     208 Pounds     Managed to lose 5 lbs before I saw the surgeon
01/24/2011     199.2 Pounds     -8.8    Day of surgery
02/24/2011     177.4 Pounds     -21.8
03/24/2011     165 Pounds     -12.4
04/24/2011     156 Pounds     -9
05/24/2011     151.2 Pounds     -4.8
06/27/2011     148.2 Pounds     -3
07/24/2011     143 Pounds     -4.8 Hit a normal BMI
08/24/2011     140.2 Pounds     -2.8
09/24/2011     136.2 Pounds     -4
10/24/2011     134.2 Pounds     -2
11/26/2011     134.8 Pounds     +.6
12/24/2011     133.6 Pounds     -1.2
01/24/2012     133.8 Pounds     +.2
02/27/2012     131.6 Pounds     -2.2
03/25/2012     129.4 Pounds     -2.2 (had jaw surgery just after this W/I and was on liquids for several weeks)
04/24/2012     121.4 Pounds     -8 (Result of jaw surgery)
08/26/2012     130 Pounds     +8.6

IF I was able to chose my cc length, it would not exceed 150. But my surgeon said between 175 to 200...I got him to agree to 175. He also does not want me below 140 (yeah, right...NOT!!!)

Basically I lost a majority of my weight in the first three months, then started slogging down to my goals.

I also measured myself every month the first year and every three after that. I have lost a total of 56.9375 inches.

So as of this week, I've lost 73 lbs. My dh has lost 128 lbs...we lost almost my entire pre-op weight between us (201 lbs) or an entire person!

Liz