Medicare coverage question

[glitter eyes 1,398]

I had my gastric sleeve over a year and half ago. It has been wonderful. My mom has finally decided to have the surgery too!! We were so excited. Then she calls her primary insurance that she has through her employer and they do not cover weight loss surgery.

She has Medicare as a secondary insurance because of her age, however the bariatric center said Medicare doesn't cover the surgery either. She has called Medicare twice to check for herself, but keeps either getting transferred around to various people or getting put on internal hold.

I thought I could reach out to this community to see if anyone has had experience with Medicare paying for this.

Any help would be appreciated. Thanks

[fatwoman1964 0]

I have a friend who had it through medicare, he has lost 128 pounds so far.

[fatwoman1964 0]

I should say that at the doctors office the bariatric brochures advertises that medicare now pays. Best wishes!

[Sharon1964 2,530]

The question is not really whether Medicare pays (they do, and they have a policy on it), but whether or not Medicare will pay if the primary won't.

Instead of calling the regular Medicare number (1-800-MEDICARE for anyone in the states), try calling the Benefits Coordination and Recovery Center (BCRC), at 1-855-798-2627. TTY users should call 1-855-797-2627.

The BCRC is usually involved when there is a question of who should pay first, but they are also involved when the primary insurance doesn't pay and Medicare makes a conditional payment on your behalf (so you don't have to pay medical bills yourself). They might be able to tell you what the policy is on this.

[2goldengirl 2,076]

https://www.medicare.gov/coverage/bariatric-surgery.html

I don't see here anything about the sleeve.

As for whether Medicare pays if primary insurance doesn't: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html#collapse-2436

I hope this helps!

[glitter eyes 1,398]

Thanks everyone for the helpful information. I will pass this on to my mom.

[jj7481 363]

Does your mom's primary not cover it because it's not apart of her coverage, or because she doesn't meet their criteria?

[GibbsGirl 483]

I of the sideways picture have Medicare and it covered my sleeve.

[glitter eyes 1,398]

@@jj7481 her primary insurance doesn't cover weight loss surgery at all. She would definitely meet criteria as she has a high BMI and multiple comorbities. She has sleep apnea, diabetes, & high blood pressure.

[cindilew 1]

Go to the internet. Look up Medicare and Bariatric Surgery. It will give you the guidelines that are to be followed and the requirements for Medicare to cover her surgery. I did it and it worked. Good luck

[JupiterinVirgo 846]

Medicare primary covers like 80%.

[terrydumont46 1,954]

I had Medicare as secondary and my primary didn't cover bariatric surgery and in my state Medicare didn't cover sleeve. By now I would think the sleeve would be covered.

[Margie122 845]

Glitter Eyes - Medicare does not cover the same things in certain states. It shouldn't be that way, but it is. I think it's covered in some states and in some states it isn't. If you called the bariatric center where she was thinking of going they would probably know as they submit to insurance all the time.