MEDICARE AND SUPPLIMENTAL INSURANCE

[LousPeachy 100]

Has anyone who has had surgery or is Pre-Op dealt with Medicare and AARP Supplimental Insurance? I have the one that covers the excess that Medicare doesn't as long as Medicare covers part of it.

I know the Doctor will discuss it when we meet after the Seminar but I am just curious to know.

Thanks,

Louise

[mtngrl 1]

I have Medicare and Tricare. In Colorado, Medicare will not pay for the sleeve. I have to pay for my surgery out of pocket.

[LousPeachy 100]

I have Medicare and Tricare. In Colorado, Medicare will not pay for the sleeve. I have to pay for my surgery out of pocket.

I can't believe that Medicare is different from state to state! That's crazy!!

From what I have read on the Dr's website and the Medicare site, it CAN be done here in TX. Leave it to the Government to screw everything up. NOTHING is simple with them.

Since Medicare covers it partially, my Supplemental Insurance will pay the difference. I sure hope I am reading it right. I DID notice however that only one type of surgery is covered for OPEN surgery. Mall,seem to be covered for Laproscopic. I think the open is Gastric Bypass if Imremember correctly.

I feel so bad for you.it just doesn't seem fair.

Hugs, Louise

[mtngrl 1]

I couldn't believe it either but it is the truth. I know people in CA and TN that got the sleeve and Medicare paid for it. They will pay for the bypass, but I absolutely do not want that. It is all good. I am paying for the surgery and should be sleeved by the end of May or early June.

[Karen W 8]

I am in Texas, and Medicare paid for band to sleeve conversion, with Blue Cross picking up the rest. I don't think it is easy to get Medicare to pay for it, but it is doable. My co-morbidities were sleep apnea, and the band was causing GERD problems. And I did not have a huge amount of weight to lose - had lost 30 with the band, and needed to lose another 50 - 55 lbs. I am almost there one year after surgery. I also cannot believe that Medicare would vary by state. I would check that out with Medicare.

[mtngrl 1]

I already checked it out with Medicare. The rules vary by state.

[joanne keeton 14]

So glad To hear from over sixty's people. I am 64 and finish up my Dr. Visits July 14. I have done everything but the phsyc eval tomorrow. I have type 2 diabetes and am on 2 insulins, high BP, had 1 knee done, my back surgery, sleep apnea, osteoarthritis. I was scared I waited too long. Dr. Says I should be approved. Hope to be sleeved first of Aug. I am encouraged by your posts.

[jlburger 1]

Hi Louise Medicare will pay for your surgery as long as it is medically necessary and then your plan F will pick up the rest. My name is Jackie and I am a agent for United Health Care I also worked in the claims department so I know this to be true and also Medicare is the same in all states hope this helps

[Sharon1964 2,530]

Hi Louise Medicare will pay for your surgery as long as it is medically necessary and then your plan F will pick up the rest. My name is Jackie and I am a agent for United Health Care I also worked in the claims department so I know this to be true and also Medicare is the same in all states hope this helps

Actually, no, Medicare is not the same in all states. There are things called National Coverage Determinations (NCD's), which apply to all states. Then there are Local Coverage Determiations (LCD's) which apply only to the state named in the document.

The database of NCD's and LCD's can be found here: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx

It's usually easier to go to the website for the Medicare Administrative Contractor (MAC) that covers your state than search the entire database. Go here and scroll down to FIND YOUR MAC about halfway down the page: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MACJurisdictions.html

[mtngrl 1]

Medicare will not pay in Colorado!! It does not pay in certain states. If you are an agent you should know this. I had to self pay.

[jlburger 1]

This is from Medicares website, the sleeve may not be. But thank you for the reference I will check it out.

Bariatric surgery

Who's eligible?

Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery, when you meet certain conditions related to morbid obesity.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Your costs in Original Medicare

For surgeries or procedures, it's difficult to know the exact costs in advance because no one knows exactly what services you'll need. If you're having surgery or a procedure, you can do some things in advance to figure out approximately how much you'll have to pay.

[jlburger 1]

This is from the Medicare website, but thank you I will check it out.

Bariatric surgery

Who's eligible?

Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery, when you meet certain conditions related to morbid obesity.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Your costs in Original Medicare

For surgeries or procedures, it's difficult to know the exact costs in advance because no one knows exactly what services you'll need. If you're having surgery or a procedure, you can do some things in advance to figure out approximately how much you'll have to pay.

1. Ask the doctor, hospital, or facility how much you'll have to pay for the surgery and any care afterward.
2. Make sure you know if you're an inpatient or outpatient because what you pay may be different.
3. Check with any other insurance you may have (like a Medicare Supplement Insurance (Medigap) policy, Medicaid, or coverage from your or your spouse's employer) to see what it will pay. If you belong to a Medicare health plan, contact your plan for more information.
4. Login to MyMedicare.gov, or look at your last "Medicare Summary Notice" (MSN) to see if you've met your deductibles.
   • Check your Part A deductible if you expect to be admitted to the hospital.
   • Check your Part B deductible for a doctor's visit and other outpatient care.
   • You'll need to pay the deductible amounts before Medicare will start to pay. After Medicare starts to pay, you may have copayments for the care you get.

Related resources

• Obesity screening & counseling
• Inpatient hospital care
• Outpatient hospital services

[Czechrn 6]

Medicare and my supplement insurance paid for my sleeve here in Nebraska.

Sent from my iPad using the BariatricPal App

[Lukeadelle 16]

Has anyone from Illinois had the sleeve and Medicare paid. How about ChampVA as secondary. When I called Medicare to see if it was covered they said yes but when I called ChampVA they said they will pay if Medicare pays but she didn't think Medicare would pay. Ugh...I think it has to do with the way it is coded. Could it be coded dif ways when it's billed?

Sent from my iPhone using the BariatricPal App

[VSGAnn2014 12,992]

I live in Missouri. I was 68 when I was sleeved. Medicare and my Medicare supplemental insurance (Mutual of Omaha) covered my costs.

FYI, my pre-op BMI was 39. I had 3 qualifying comorbidities -- arthritis, lower back pain and stress incontinence.

Very best to you.