Medicare Process?

[citygirl1962 50]

Has anyone used Medicare as their primary insurance for their surgery? I understand Medicare does not "pre-certify" so what is the process? Does the surgeon still send the file to Medicare?

Thank you!

[MollyF22 62]

I'm from ohio and use caresource. Not really sure if it's medicare or medicade but I have a 9 month supervised visits and I just got done with my 7th. I will be done in January. I had to have 2 clearances done and my bmi has to be over 50 in order for them to completely pay for it. It will take any where between 1 week to 45 days to get approved.

I think it depends on states and how all of it works. I think once you find where you wanna go then it all should work out

[sharowna 6]

Hi, Thank you Molly!!

[citygirl1962 50]

Medicare is a federal program and no longer requires a medically supervised diet. It does require that you have tried to lose weight.

[Jaydasma 0]

I had Medicaid when I had my surgery in July! I didn't have a problem. They worked fast to get my surgery done

[citygirl1962 50]

Medicaid and Medicare are ENTIRELY different. Medicaid is based on low income. Medicare is a federal program based on age or disability. Has anyone used MEDICARE?

[sharowna 6]

thank you citygirl1962 I have Medicare and in the process of approval on panniculectomy. I've obtained my estimates and awaiting approval which I believe is the next step. I've been assessed by PS @ HH rochester, ny. sharowna

[juliek1968 1]

Sharowna have you heard from medicare for your panniculectomy? I went in dec to see the plastice surgeon for panniculectomy and am wondering if it will be covered. I called last week of dec and was told medicare requested more info from doc. I really would like this done. I have had rashes for 6 months now, but never went to doc cause I was embarrassed. Its funny though cause the plastic surgeon saw me and said he could have it approved within 2 weeks and could have surgery in January till he heard I had medicare. Now its a wait and see.

[Dar200 285]

I have Medicare and it paid 80%. I'm in Texas and was told that Medicare pays for WLS in some counties in Texas, my county being one of those. I did not have to go through a long process of dieting under the supervision of a nutritionist. I just had to do a thirty day program showing I was able to follow a diet enough to lose some weight. That was the length of time my surgeon required. I talked to another doctor's office in the same city and was told 90 days were required. So I called Medicare directly to find out why I was hearing the discrepancy. The lady I talked to read me the portion of the coverage that explains that and it seems that it is up to the surgeon as to how long you are required to do the pre-surgery supervised weight loss. This is evidently a fairly recent change in Medicare requirements. I hesitate to even reply to questions on Medicare coverage because it is confusing, doesn't make sense logically, and I got different answers from different surgeons offices. This was the bottom line in my case: (1) Medicare approved me for surgery immediately following my first appointment with my surgeon. Just as an aside, I had a very high BMI and comorbidities. (2) When I was first weighed by my nutritionist a week later, I was told that if I gained any weight at all from that weight until my follow up visit thirty days later, Medicare would not cover the surgery. (3) I think it still depends on where you live. So if I were to have to start this over tomorrow with no referrals from a current doctor, I would call three surgeon groups in your city and ask to speak to a patient coordinator who works on insurance approvals/qualifying.

[Dar200 285]

Sharowna have you heard from medicare for your panniculectomy? I went in dec to see the plastice surgeon for panniculectomy and am wondering if it will be covered. I called last week of dec and was told medicare requested more info from doc. I really would like this done. I have had rashes for 6 months now, but never went to doc cause I was embarrassed. Its funny though cause the plastic surgeon saw me and said he could have it approved within 2 weeks and could have surgery in January till he heard I had medicare. Now its a wait and see.

What is panniculectomy? Thanks.

[juliek1968 1]

Thank you Dar200. I had the sleeve done back in jan 2014. A panniculectomy is the removal of the skin that hangs off the stomach. Ins doesn't pay for tummy tucks, but if found medically necessary will pay for removal of skin.

[Dar200 285]

I have huge amount of hanging fat/skin. I'm going to check into that. Thanks for the info.

[juliek1968 1]

Your welcome!! You need to have a rash and documentation to have it medically necessary.

[ACV 34]

Good to know.

Edited February 9, 2016 by ACV

[Dar200 285]

Medicare accepted my failed attempts at weight loss. I just listed Weight Watchers and the dates I was trying to do that, Jenny Craig and the dates for that and one other thing. They did not require any confirmation from Weight Watchers or Jenny Craig, just my general explanation of when I did the programs and the results of each program. For example, I did Weight Watchers from June 2015 to December of that year, I lost 15 pounds but regained 20 pounds by May 2016. Not accurate for me, but just an example