Should Medicare/Medicaid cover the band?

[wrk-n-prgrss 0]

Just wondering what everyones thoughts are on this subject. I do have a friend who retired and is going to get bypass which will be covered by medicare. Her insurance wouldnt cover it while she was working.

[anonemouse 1]

Well, I think that if they are going to pay for the bypass, they should definitely pay for the band. And I also think that, in the long run, they would be paying far less if they paid for WLS than if they didn't, if you consider all of the health conditions that obesity contributes to.

[wrk-n-prgrss 0]

Well, I think that if they are going to pay for the bypass, they should definitely pay for the band. And I also think that, in the long run, they would be paying far less if they paid for WLS than if they didn't, if you consider all of the health conditions that obesity contributes to.

Thats true they probably cover the band then. I actually dont know how I feel about this issue. I am glad that some who maybe couldnt get weight loss surgery have access to it, but at the same time that means you have to be either poor (I am not actually sure if Medicaid covers it, but I think they do in some states) or over 65 to be covered. That leaves many hard working people who cant get it.

[anonemouse 1]

Thats true they probably cover the band then. I actually dont know how I feel about this issue. I am glad that some who maybe couldnt get weight loss surgery have access to it, but at the same time that means you have to be either poor (I am not actually sure if Medicaid covers it, but I think they do in some states) or over 65 to be covered. That leaves many hard working people who cant get it.

Very true. But I don't think that the people who are elligible for the program should be punished because other people aren't. Unfortunately, it's just the way our medical system works. Some people have access to procedures that other people don't. I don't know the answer to that problem.

[SlimTarnishedDiva 1]

In my state(Maryland) Medicaid pays for both gastric bypass and the lap band. There were a few people at the seminar I went to that asked quite a few questions about Medicaids coverage. However, a lot of Surgeons won't accept it still because of Medicaids slow payment for gastric bypass.

[BLUE EYED GIRL 0]

I THINK IT SHOULD,AUSTRALIA IS ALWAYS GOING ON ABOUT AUST WEIGHT PROBLEM,I THINK IF YOUR BMI IS OVER 40 THEN IT SHOULD BE COVERD,MY HBF PAID FOR MINE TOTALY,I WAS VERY FORTUNATE,I WAS ONLY SLIGHTLY OUT OF POCKET FROM ANETHATIST.MAYBE MORE PEOPLE WOULD HAVE THIS PROCEDURE IF IT WAS COVERD/LETS FACE IT,ITS A DANGER TO YOURSELF BEING OVERWEIGHT,AND WHO CAN HONESTLY SAY WE ARE HAPPY AT OUR FATTEST.

[Jachut 487]

Its the same here, medicare (our socialised medical system) DOES cover banding and you can get it done for nothing. If you want to wait on a waiting list for 8 years that is. Some surgeons will do it quite quickly. Of course you can go self pay which should be the same as a privately insured patient but most will not touch a self pay patient with a bargepole, for fear of them running out of money if there's complications etc.

So you basically need private health insurance to get it done.

Which angers me because apparently only rich people get fat, or if everyone gets fat, only rich people deserve to be able to do anything about it.

[BLUE EYED GIRL 0]

I Didnt Know Medicare Coverd It At All[even Arfter 8yrs?]might Be Differant Depending Whear You Live. My Friend Paid For Her Lapband,she Mentioned Claiming It On Her Tax,not Sure What She Got Back,she's Getting A Tummy Tuck And Skin Removed From Other Areas[good For Her,she Already Looks Fabulous]it Is A Huge Expense,no Matter Weatheryour Having Implants Or Weight Loss Surgery,you Have To Do Whats Best For Yourself,you Only Live Once,we Need To Enjoy Life.its Not Being Selfish.its Also Not A Matter Of Being Rich To Have Private Health,its Getting Prioraties Right,for What We Have Paid Over The Years To Hbf,i Have Paid For My Lap Band Over And Over,and Because Of That Other Benifits Are Included,due To Long Membership,wich Is Well Deserved.

[Wheetsin 714]

This is a toughie. It really is. I've thought about this before. I know my thoughts on most welfare programs tend to go against the flow, but I certainly don't think for even a second that I have all the answers. And sorry, I can already tell that this will be more me thinkig out loud, than actually providing a concise answer.

I think Medicaid should offer the treatment that saves the most money. Period, no choice involved. If WLS will save money, then offer the surgery with the highest chances for lifestyle success and has the lowest long term/population costs. In the case of Medicaid, I think this should be RNY. Yes complications are higher and probably cost more to resolve when they arise, but I think that when you consider ALL factors (compliance/results, diet, aftercare, etc.) it's probably the better choice.

I would also like to see stricter requirements in place for Medicaid-funded procedures. You don't have to read too many posts here to see people trying to find ways to cheat the system, and a LOT of others willing to help them do that. So we know that ethics around qualifications aren't up to really super high standards. According to some of these stories, it's "easy" to inflate your BMI. And the same is true for comorbidities... if I had a dime for every time I've read something like, "You don't really need comorbidities, just tell them your knee has been hurting" then, well - I'd have a lot of dimes. I think the psych visit should look for specifics and require a solid program of behavioral change, not just be a checkmark needed on the road to WLS.

Point being, if the procedure is going to be funded through Medicaid, then I think NEED has to be established, and it needs a method of establishment that's a little more resistant to people trying to cheat the system. Again, I don't even pretend to think I have all the answers, but some requirement that requires either a life-threatening condition or some other medically necessary (truly medically necessary) need, or enough analysis of evidence to prove that the WLS will bring ROI. (As if states have that kind of manpower... dream on).

See, I'm really not very compassionate. I think the 10%, 15% of people who really and truly need the assistance should get it, but I don't think they should get it at the expense of the 85% - 90% who don't. (Those aren't researched numbers, they're anecdotal from people I know who work in my state's family services programs).

[WASaBubbleButt 41]

I have mixed feelings about cheating the system. I think it is the system that is out of whack.

The US is the only country I am aware of that requires someone to be severely obese (35+BMI) or morbidly obese (40+BMI) before they will do anything. By that time things are out of control and they will likely have comorbidities. That makes no sense to me. The places outside the US that band at 30 make more sense to me and I suspect it would be cheaper in the end. Instead of treating heart problems, diabetes, etc. it could easily be prevented.

There was one person that I still remember from OH that I was floored when I read her post. She was banded under welfare and thought she had something like a $20 copay for fills and she wanted to go back (using welfare dollars) and get a revision to bypass because she didn't feel she should contribute to her own health care.

I made the point that people do amazing things to come up with the money for cash pay for surgery, they dig for treasures while dumpster diving and ebay them. They sell their homes, refinance their homes, get 3rd jobs, etc. They will do anything to get this surgery CASH PAY. And she was whining about a $20 copay for a fill?? She was willing to let the taxpayers pay another $30K+ for revision surgery so she could save a few bucks on fills??

I got blasted by all the other welfare people for suggesting she get a job, afterall, she has welfare.

I wasn't suggesting she get a job, I was explaining what people will do to get a band and she was throwing a fit over $20? THAT blows my mind. The mentality of the world needing to support them and the mere thought of putting forth a penny for their own heath care being nothing short of a horror.

I support banding for welfare type folks, they need it every bit as much as non welfare folks and the cost and medical complications of bypass (not to mention future failures requiring band after bypass revisions) is potential to be huge.

But I also feel that welfare is a needed thing in this country but if I were to start a welfare program in a new country I'd surely set it up but it would be much different. If someone needs a bit of help, give it to them. Then give them a set time to repay the money. Obviously there are people who could never repay but for those that have the time to sit home and make more babies, they have the time to get a job.

[babs0101 1]

I have mixed feelings about cheating the system. I think it is the system that is out of whack.

The US is the only country I am aware of that requires someone to be severely obese (35+BMI) or morbidly obese (40+BMI) before they will do anything. By that time things are out of control and they will likely have comorbidities. That makes no sense to me. The places outside the US that band at 30 make more sense to me and I suspect it would be cheaper in the end. Instead of treating heart problems, diabetes, etc. it could easily be prevented.

There was one person that I still remember from OH that I was floored when I read her post. She was banded under welfare and thought she had something like a $20 copay for fills and she wanted to go back (using welfare dollars) and get a revision to bypass because she didn't feel she should contribute to her own health care.

I made the point that people do amazing things to come up with the money for cash pay for surgery, they dig for treasures while dumpster diving and ebay them. They sell their homes, refinance their homes, get 3rd jobs, etc. They will do anything to get this surgery CASH PAY. And she was whining about a $20 copay for a fill?? She was willing to let the taxpayers pay another $30K+ for revision surgery so she could save a few bucks on fills??

I got blasted by all the other welfare people for suggesting she get a job, afterall, she has welfare.

I wasn't suggesting she get a job, I was explaining what people will do to get a band and she was throwing a fit over $20? THAT blows my mind. The mentality of the world needing to support them and the mere thought of putting forth a penny for their own heath care being nothing short of a horror.

I support banding for welfare type folks, they need it every bit as much as non welfare folks and the cost and medical complications of bypass (not to mention future failures requiring band after bypass revisions) is potential to be huge.

But I also feel that welfare is a needed thing in this country but if I were to start a welfare program in a new country I'd surely set it up but it would be much different. If someone needs a bit of help, give it to them. Then give them a set time to repay the money. Obviously there are people who could never repay but for those that have the time to sit home and make more babies, they have the time to get a job.

AMEN! I agree!

[sfeiner 2]

I'm glad they do. That's how I got it. Another good point is that the rest of the insurance usually eventually follow suit when medicare does something . Sharon

[sfeiner 2]

I now see that that question said medicare/medicaid....I think Medicaid on the other is a freebie for people who aren't working. I have very mixed feelings about that paying. I guess if a person is disabled by thier weight, it would be cheaper in the long run to get them slimmed down enough to become prductive tax paying citizens. Sharon

[Serena 0]

I think that you can qualify for SSI (disability for people who do not have enough work credits to qualify for regular Social Security disability benefits) on the basis of morbid obesity alone. If these folks were to receive WLS, theoretically they could re-enter the work force and end up saving more than the cost of the surgery.

I do admit to being really annoyed at my first WLS seminar (for a different hospital than the one I chose). When the Medicaid recipients heard that there was a $300 program fee not covered by insurance, a few of them got hostile.

Medicare recipients are usually responsible for $1,000 for WLS

(Medicare pays 80% of what it determines is the UCR) plus the program fee. Medicare does not pay for fills.

[nina874 48]

We dont have medicare here but I suppose I could use the NHS as an example.

I actually had a very good friend die I feel as a direct result of the management of her VMO program. She was never offered any type of surgery,she weighed 400lbs+ and she had mulitple co-morbidities, instead she was put onto a Lipo TRIM/Cambridge diet type program where all she could have all day was 3 shakes and Water or black coffee.......she was on it for 18 months.

She was monitored by the hospital and they had agreed to do a Tummy Tuck as she had an emormous apron that caused her all sorts of health problems, only they gave her another 3 months to lose even more weight.As the time got closer she panicked, it was summer and surprisingly enough for England it was hot, she didnt eat anything for 4 days and started having breathing difficulties. She had a massive heart attack and died in the back of the ambluance, she had 3 little kiddies and the eldest was only 10.

Do I think that she should have been offered weight loss surgery on the NHS? Do I think that she might still be here today if she had? Yes yes yes! She had worked her whole life until her weight issues made her too ill to be able to walk anything more than short distance, the NHS let her down and now a beautiful soul is dead and her kids have no mum.

Over here if you want PRIVATE banding you should have a BMI of 35 with co-morbidities, or over 40 without .Although I had severe reflux I still had to sign pages of legal work to cover the clinic as my BMI was only(!!) 36.8 at my initial appointment!

The shysters will always want something for nothing, but a lot of the people who are very morbidly obese did work and contribute, and being brutal, it will probably save the government money in the long run.

Nina x