New Medicare Changes....

Lee4love1 · February 15, 2007

:mad: Has anyone heard about the new changes with Medicare and Medicaid on "Bariatric surgery"?

Well, I was approved as of Jan 21-07. Then about Feb-4th-07 a new memorandum comes down. All patients wanting the surgery, must present more than 5 current weights. So with this being said--(I have to wait 3 more months--unless I get my records) He or she must show at least 2 times of weight loss failure. Today I had to track down my doctor on the coast. (Gulfport, MS). I had to have them fax the St Francis Hospital Bariatric center. It's now from (2002-2005) and now (2005 to 2007) for my new Dr. We're talking of at least 6 times a year that I went to the Dr/ I'd go every 60 days--since I had a weight issue--I was even asked if I could obtain my VA file. That's me sitting at the VA part of the day--I am not even sure if I can sit there too long. I may have to show up at records and get a copy of my file too...(1989-present)

The US made a deep cut into the medicaid. So now they are monitoring closely if we "morbidly obese" folks really need the surgery.

It's like I woke up in January and I went from 175 to 270 over night. It's cool, I had my records faxed quickly within 24 hours. My hope is still to have my lap band done in march.....:faint:

SJB · February 20, 2007

Be thankful that you have the Medicaid/Medicare option. As an emplyee of the state of MS, I am paying for health insurance that will not even entertain the idea of paying for WLS - they go as far as to have an exclusion clause. :mad: I will be paying for my surgery, fills, everything myself. Hopefully it will all work out for you and they will approve your surgery. Good luck!

Lee4love1 · February 20, 2007

Oh....don't misunderstand me...Since I left my Goverment Job--I have Medicare and Blue Cross and BLue Sheild....When this is a fact and you retired due an injury--Medicare is the Primary insurance that controls the total deal I pay close to $500 a month in insurance--but here is this $98 insurance trying to stop me. Oh--I went on just last week and got 5 years of my weights and measures. They wanted at least 3 weight loss failures. My old Drs and new ones got them 6 years of medical facts. My surgery is on. I see Dr Weaver-Mcgraff on 28-Feb. She will gve me a few dates that is good....I am ready for this 9 days to pass. I am looking forward with a possible March 3rd through the 15th date.....So since I overcame the red tape...I am A-OK now....Lee

SJB · February 20, 2007

So glad everything is working out for you --just makes it seem all the more like it was meant to be. I know our state has a good retirement plan, but their insurance plan really steams me. Seems unfair that they can raise their ugly head at you as well, given the circumstances. Where is Dr Weaver-Mcgraff located? I know you can't wait for your surgery date...I can hardly wait to see Dr. King in March for my first visit. Let us know how it goes!:mad:

Lee4love1 · February 20, 2007

Dr Weaver-McGraff is Located in Memphis, TN at the St Francis Hospital==at the Bariatric Center there. It's about 30 miles from me. So I have to cross over to the next state--but it's ok by me. I was told by the Program director--withing 2 weeks after I see her(the Dr)--I'll be scheduled for the surgery.. I am trying to prepare my mind now for the lifestyle change. I am still finding myself hungry on a few days too, but I have been eating lighter. Plus--the band will give me relief from that hunger pain--thank God. I will not say too much to those "So called Friends of Mine"--who all said it was a waste of time or they heard it's dangerous--I will just show them. It's hard to convince folks who don't know our struggle. I am in the mindset to lose the weight and achieve max results. they said 2 pounds was the Max--but as I have read numerous articles on the lap band and have read sooo many results all over the net--there are people doing excellant and getting at 3 pounds a week and maintaining that for 9 or 10 months before theylevel off to a managble 1.5 to 2 a week. My goal--to have a reasonable amount loss by December. I know the "new Lee" is in there waiting to pop out...lol....I hope it's possible to have at least a 65 to 75 pounds loss in 9 months.....I will keep you informed....Peace

SJB · February 24, 2007

I know what you mean - I don't want to say much either - I just want folks to see the results. You're right, people just don't understand our struggle. Keep the great attitude - I think that is half the battle.

:clap2:

Lee4love1 · February 24, 2007

Hello SJB...I will be keeping the faith and getting out of the way of the old "Lee"...I sure hope my spirits will be lifted very soon...I hate waiting--but as I wait--I inch closer....Speaking of "inches"...I am looking forward to losing at least 10 inches off my waist line and at least 8" from my chest