Medicare?

[Need4Change 26]

Hi! I was just wondering if anyone has had experience with getting an approval while on Medicare? I have BCBS of FL through my spouse as a primary and Medicare as a secondary. My doctors office said that my BCBS won't cover the sleeve, but Medicare will. I am curious about the requirements and out of pocket expense with Medicare. Thanks in advance!

Kim

[ProudGrammy 8,322]

doctors office said that my BCBS won't cover the sleeve, Medicare will

@@Need4Change

welcome, welcome, welcome to the Bariatric Pal Boards

you just made your first post too!!

ask many questions from the board

people will give you good suggestions/thought/experiences

but at the end of the day ..................

always only listen to your doc and NUT (nutritionist) and me of course

doctors office told you BCBS won't cover WLS???

i would double check on that statement

even though they (office) have total/much experience working with insurance co.

they shouldn't tell you automatically you won't be accepted

the same way they shouldn't tell you were approved

they are not the official final word

talking for the insurance company i think is irresponsible

5 years ago Medicare wasn't accepting the sleeve

(i was denied)

no ifs, and, or buts!!!

"they" considered the sleeve to be experimental!!

(side note, my secondary BCBS finally approved after many long "discussions"

Medicare now does accept the sleeve

don't think it is different state to state

medicare is federal? so it should be accepted, "i think"

as long you have many physical problems

needed to be accepted by surgery

ie diabetes, high blood pressure etc

MEDICARE "probably/should" accept

you "should" be approved

if you do have a problem with approval. (medicare or BCBS)

going to another country ie Mexico is always a good option

many, many people have gone that route with great success

i didn't go to Mexico since insurance finally accepted me

prices vary

Four Thousand Dollars to................

when (if) you hopefully get approved - write down a list of questions to ask surgeon

listen carefully, write down his responses/ facts

do lots of research about the different surgeries

i'm biased since i had the sleeve - i think its best

you can now make an informed decision and chose whichever surgery is best for you

good luck

kathy

Edited March 12, 2015 by proudgrammy

[Need4Change 26]

Thanks Kathy! I guess I'll go ahead and introduce myself...

My name is Kim. I am 40, married and have 4 children (21, 9, 6 and 8 mos.) I was declared disabled in 2011, with chronic debilitating Migraines. I have had the migraines since I was 12, but the frequency and severity reached epic proportions around the time I hit my 30's. As the migraines persisted over the years, I gained weight and developed chronic hypertension. In time, I also developed high cholesterol. In June 2014, I was 8 1/2 months pregnant with my son, when my blood pressure (195/115) earned me an emergency c-section. Stemming from that pregnancy and delivery, I ended up with postpartum cardiomyopathy and congestive heart failure.

The boat I currently sit in, is not wanting to be the fat girl in the room anymore. My BMI is barely 35, but I can already see myself turning into my mom (I would imagine her BMI is 40ish). My parents have passed along some pretty poor genetics and that tips the scales even more. My father died of colon cancer at 59 and my mother fought and beat brain tumors (at 27), breast cancer (at 29) and has been battling lupus since her 30's.

Given my obnoxious genes, my medical history (I failed to mention my sleep apnea diagnosis 5 years ago and the fact that I was a gestational diabetic for 2/4 pregnancies) and my BMI, I am really hoping to qualify. I've already met my potential surgeon, as he removed my gallbladder in December. I have my consultation next Thursday and I am READY! I am hoping for a smooth approval and for things to move in a timely fashion. That's not too much to ask for, right? ????

Any input regarding medicare, BCBS of FL, my health history, or anything else - is welcome!

Thanks for reading my novel!