Medicare

[choosehope 233]

Anyone use Medicare for Gastric Sleeve? Did they pay for it? What was the process for getting it approved?

[Jb1176 79]

Sleeved 4/13 with Medicare primary and Blue Cross Blue Shield supplemental. Surgeon said Medicare didn't need prior approval if records showed co morbidity with one extra condition because I had a BMI <40. My BMI was 38. I have not had a single piece of paper from Medicare indicating they were not going to cover the surgery. My supplemental has already paid their share. I received that notification yesterday.. A friend had bypass 18 months ago under Medicare and she never received a bill for any part of the surgical costs.

[Findingmeoncemore 2]

Sleeved 4/22/2015. I used Medicare with a plan F supplemental. The clinic I went to got all the prior approval. There are some costs that medicare would not cover. A blood test for Iron, and a stool test for blood. But I believe the reason they didn't pay was the coding the lab/dr. used. They also do not pay for a nutritionist after surgery. So I declined to go to one. Once medicare denys then the supplement also denies. On the good side, I received the hospital statement. 37,000 and it was covered 100%. No co pay, no deductible. I think it was so high because they found a massive hernia while they were in there.

[Sharon1964 2,530]

If you don't have some sort of supplement, you would be better off buying one before surgery (check if there's a waiting period before they cover surgery).

If you don't have a supplement, you'll be paying the first $147 of outpatient care (part B deductible), then 20% after that. On a high level office visit, that will be around $30, depending on where you live.

For hospital inpatient care, you'll pay the first $1260 (part A deductible), then nothing else for the first sixty days in the hospital.

[NDKim 0]

I have United Health Medicare Complete. Does anyone out there in computer land know what my bill will be for a sleeve? Anxious to hear!

[Gwenlucy 6]

I had red, white and blue medicare and it covers 80%

[Sharon1964 2,530]

I have United Health Medicare Complete. Does anyone out there in computer land know what my bill will be for a sleeve? Anxious to hear!

Your best bet is to call United and ask them directly what the coverage is for vertical sleeve gastrectomy, including one or two days of hospital inpatient charges.

For the surgeon: If they tell you they need a CPT or Procedure Code for the surgery, it is 43775. If they want an ICD9 diagnosis code, it is 278.01, morbid obesity.

For the hospital: If they want an ICD9 hospital procedure code, it is 43.82. If they want a DRG or Diagnosis Related Group code it will be 619, 620, or 621 (depending on absence or presence of complications and/or comorbidities).

Of course, there are no guarantees as your surgeon, for example, may have to change from lap to open surgery mid-procedure.

[kozyjozie 108]

I have Medicare as primary and Medicaid as secondary. I was approved right away. My bmi was 39.4. Now it's 38. They did not require me to lose any weight. However I did to make the surgery easier. I only was required to have one nutritionist visit. I have my surgery date for August 17th. I'm nervous and excited to start my new life.