Will I Be Covered?

[Terrilen 0]

I currently have United health Care and by the grace of God all my Lap Band needs have been covered. I am on social security disability and in Febuary finaly qualify for Medicare. My question is....does anyone else have Medicare and does it cover care associated with your band? Thanks alot!

[SalOdyssey 441]

This Is Something I Want To Know. As I Qualify For Medicare In April. Gonna Call Them After The New Year To Find Out More Info. My Specific Question Is Does Medicare On Disability Cover The Lap Band??

[Lap_dancer 8]

I keep seeing the appearance of the words "Centers of Excellence" for insurance coverage of Lap Banding. This is what I found for Medicare:

Medicare has made a landmark decision to cover the gastric bypass and LAP-BAND® procedures for patients meeting specific criteria (see below). Coverage will be approved only when care is delivered by surgeons and facilities that have received the ASBS (American Society for Bariatric Surgery) "Center of Excellence" designation.

ASBS designated Dr. Johnell and North Colorado Medical Center

as a Center of Excellence on October 28, 2005.

Our program immediately qualifies for Medicare coverage.

To find out if you qualify for bariatric surgery and for more information, please read below!

The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS), are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity.

CMS has determined that covered bariatric surgery procedures are reasonable and necessary only when performed at facilities that are: (1) certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (BSCOE) (program standards and requirements in effect on February 15, 2006).

To view Medicare's decision memo dated February 15, 2006, please click on the following link:

http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160

The next step for me would be calling my doctor. The insurance secretary would be the one who could tell you, however if they said NO, it could be because you don't meet the criteria which is listed above.

[juliegeraci 7]

UHC did not cover my fills. I've had $800 out of pocket. YOu may want to research. Good luck.

[Lap_dancer 8]

This Is Something I Want To Know. As I Qualify For Medicare In April. Gonna Call Them After The New Year To Find Out More Info. My Specific Question Is Does Medicare On Disability Cover The Lap Band??

See this is the part that scares me. While Sparadiso8116 is covered...

TerrilenI currently have United health Care and by the grace of God all my Lap Band needs have been covered. I am on social security disability and in Febuary finaly qualify for Medicare. My question is....does anyone else have Medicare and does it cover care associated with your band? Thanks alot!:welldone:

Terrilen is not.

Wow. I am seeing more and more of this select and choose method of coverage which tells me one thing, we all need to know more about our insurance than the people that work at our insurance companies.

[2bthinagn 3]

This Is Something I Want To Know. As I Qualify For Medicare In April. Gonna Call Them After The New Year To Find Out More Info. My Specific Question Is Does Medicare On Disability Cover The Lap Band??

Did you get your answer on Medicare covering lapband. I have been on this road since Nov 2005. My secondary was gonna pay for mine UNTIL Medicare jumped in Feb 16 2006. Now they say medicare has to pay first. OK...Medicare does cover lapband if your BMI is a certain amount. What state are you in? They will only cover this if the procedure is done at a "Center of Excellence" not all hospital have that designation. And IF you are lucky enough to have one close to your home, some of the Dr's wont take Medicare so you are out of pocket for their part. Let me know what you have found out. I am still waiting for for a facility in the Kansas City are to get designation.