Should Medicare/Medicaid cover the band?

[Telecia 1]

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.

Yes if you dont have enough work credits you can qualify for SSI. For Obesity? That I dunno. I would tend to think there would need to be other things like the co morbities that would be the actual qualifying factor. I know I got mine for my back. I had only done 3 1/2 years in the offical workforce so had to deal with SSI (which is LESS then half what can be gotten on normal disability) Acually I worked it out My SSI equals earning 2.50 and hour for a 40 hour work week. But each state varries.

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.

This is actually quite understandable. Since to qualify for Medicaid you have to have a REALLY low income.

Public Web

300$ to me is a allot of money. Is it right to force people to come down to making a decision like getting the surgery for your health or buying groceries for your family for the month?? Or not paying a good portion of your rent/house payment?

One of my biggest pet peeves is the fact that if your on medicaid/welfare/SSI they will NOT take allot of things into account like: If you have ANY life/burial insurances they are counted AGAINST you. If you have a car its counted against you. They do not count car insurance/home insurance or telephone (or transportation if you do not have a car) in your expenses because these are all LUXURIES. [tell that to the nice police officer who just gave you a nice big FAT TICKET or impounded your car, cause you don't have insurance on your car]. The whole system is one huge FLAW.

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.

Thats not right. I know of several people on medicare who worked themselfs half to death to get to the age to retire and for whatever reasons are forced to live mostly on what social security they can get. That have to rely on medicare. Who certainly cant afford 1000$, and to pay the fills out of pocket.. Heck allot of the people I know have a hard enough time keeping their homes because of the cost of perscriptions and other 80% of things that medicare dose not cover. although enough public outcry has happened in the last 10 or so years this is slowly getting better.

[WASaBubbleButt 41]

This is actually quite understandable. Since to qualify for Medicaid you have to have a REALLY low income.

Public Web

300$ to me is a allot of money. Is it right to force people to come down to making a decision like getting the surgery for your health or buying groceries for your family for the month?? Or not paying a good portion of your rent/house payment?

I think there are two sides to that story. What about the working poor? They are out there doing really hard jobs, washing cars, washing dishes, digging ditches, hard manual labor. They are out there doing their thing in society and they get ... not a lot. Certainly less than free medical care. People are going to shoot me for writing this but the truth is I'd rather help the working poor over others in many cases.

Medicaid patients have to pay $300. The working poor often times have to pay for the entire surgery. They have to pay $8K+. I'm not sure that is fair either. They simply don't have the option of having surgery at all. If I had to come up with $300 as a poor person that would be one hell of a lot easier than coming up with $8K+.

I've seen what people do to come up with the money to pay for the entire surgery. They sell off personal items including their computer and they stop internet service. They sell their car, their home. They'll do anything to get the surgery down to dumpster diving and selling treasures on ebay.

Then people who are getting the surgery for free throw a fit over paying $300? Nope, not buying it.

One of my biggest pet peeves is the fact that if your on medicaid/welfare/SSI they will NOT take allot of things into account like: If you have ANY life/burial insurances they are counted AGAINST you. If you have a car its counted against you. They do not count car insurance/home insurance or telephone (or transportation if you do not have a car) in your expenses because these are all LUXURIES. [tell that to the nice police officer who just gave you a nice big FAT TICKET or impounded your car, cause you don't have insurance on your car]. The whole system is one huge FLAW.

Most employers don't take those issues into account either. That's how life works. That's how it is for EVERYONE.

If my house payments go up my employer doesn't care, I get paid what I get paid. If I choose to break the law and fail to pay for car insurance and get caught, my employer doesn't care. No employer cares.

Thats not right. I know of several people on medicare who worked themselfs half to death to get to the age to retire and for whatever reasons are forced to live mostly on what social security they can get. That have to rely on medicare. Who certainly cant afford 1000$, and to pay the fills out of pocket.. Heck allot of the people I know have a hard enough time keeping their homes because of the cost of perscriptions and other 80% of things that medicare dose not cover. although enough public outcry has happened in the last 10 or so years this is slowly getting better.

Social security and Medicare were never designed to be the only source of income. It was designed to be an added source to retirement savings.

With that said I'd rather those dollars go to those who paid into the system, not everyone else.

[Wheetsin 714]

I agree so much with what has been posted.

I can't find the thread now, but a similar topic came up once upon a time. May have been archived by now. But in it, I asked self-pays (and others, but it was directed at self-pays - specifically ones who had a really hard time getting the money raised) how they felt that they couldn't afford the band, while Medicaid recipients had been banded on others' dime. The responses were very mixed, IIRC.

Saying that it's not fair to make a Medicaid recipient choose between the band or optional surgery (I will use the word optional as a qualifier because no one who had the band would have died in 3 hours if they didn't, so we aren't talking about something that has to be done right now or you will die) -- why should people on Medicaid not have to make that decision, when working/contributing people have to make it every single day?

I can guarantee you some of the self-pays had to make the decision between groceries or the band at some point, and they still did it because the band meant that much to them. People have sold their cars and walked everywhere instead. People have given up medications they needed so they could apply what they would have paid for their prescriptions toward the band.

This is the akward position of the population Wasa brought up. Yeah, they work, they contribute, but they're barely making it -- IF that. And they have to make choices like that all the time.

[WASaBubbleButt 41]

I agree so much with what has been posted.

I can't find the thread now, but a similar topic came up once upon a time. May have been archived by now. But in it, I asked self-pays (and others, but it was directed at self-pays - specifically ones who had a really hard time getting the money raised) how they felt that they couldn't afford the band, while Medicaid recipients had been banded on others' dime. The responses were very mixed, IIRC.

Saying that it's not fair to make a Medicaid recipient choose between the band or optional surgery (I will use the word optional as a qualifier because no one who had the band would have died in 3 hours if they didn't, so we aren't talking about something that has to be done right now or you will die) -- why should people on Medicaid not have to make that decision, when working/contributing people have to make it every single day?

I can guarantee you some of the self-pays had to make the decision between groceries or the band at some point, and they still did it because the band meant that much to them. People have sold their cars and walked everywhere instead. People have given up medications they needed so they could apply what they would have paid for their prescriptions toward the band.

This is the akward position of the population Wasa brought up. Yeah, they work, they contribute, but they're barely making it -- IF that. And they have to make choices like that all the time.

There was a quote in a previous post that is still eating at me and I'm going for it.

One of my biggest pet peeves is the fact that if your on medicaid/welfare/SSI they will NOT take allot of things into account like: If you have ANY life/burial insurances they are counted AGAINST you. If you have a car its counted against you. They do not count car insurance/home insurance or telephone (or transportation if you do not have a car) in your expenses because these are all LUXURIES. [tell that to the nice police officer who just gave you a nice big FAT TICKET or impounded your car, cause you don't have insurance on your car]. The whole system is one huge FLAW.

Those are luxuries. How many people work full time, maybe two full time jobs and they don't have all the above?

Damn straight those items should be considered for welfare folks. Many who work have few/none of the above. Yet they are paying taxes so others can have it. You really don't see a problem with this picture?

If you don't have insurance on your car, don't drive. Plain and simple. It's against the law to drive a car without insurance. It's people who drive without insurance, get in accidents, don't pay their own damages, and the rest of us have to pay their share as well.

Welfare is not a right. I don't even believe it should be something offered long term. My idea of welfare is to give people a bit of help and then give them a certain amount of time to pay it back.

The days of the rest of the world owing others a living are coming to an end. People are fed up, they aren't taking it anymore.

I suspect there will come a time when those paying the bills will band together and finally change things. People will have to start working, supporting themselves. Can't do it? Find a family member who will support you, your church, your friends. But the taxpayers are sick of it.

If I have to pay taxes for welfare I'd MUCH prefer to help the working poor.

I'm all for helping people out when they are down and out. But the system is set up to be taken advantage of. People who really do need it don't get it or don't get enough while people fully able to work or live with someone who should be supporting them get it instead.

Yes, the above are luxuries and they are not something you have a right to. A car, a phone, etc... those are not necessary for survival. People who do not work do not deserve those items more than someone who works and pays taxes.

I see a serious problem with the "give me" mentality and that is what is going to piss off enough tax payers to actually do something about the welfare mentality of the world owing people a living. But, some people really believe the world owes them. They are the people that will be the least prepared when the freebie dollars come to an end.

[jenncore 0]

I live in MA. and about 12 years ago we had a huge welfare reform. Years ago, people lived on welfare. The more kids you had , the more money you got. With welfare reform, you have a two year limit after your child is born to either go to school or get a job.You will only receive a slight increase in welfare if you have a second child and then not a dime more if you have more than that. The state will pay for daycare and offer training at little to no cost as long as welfare recipients comply with going to school or getting a job.

Welfare was designed to assist people during a difficult time, it's not meant for someone to live on for a lifetime. The system is definately flawed. Sure there are people who receive welfare who really need it, there's also a huge population of people who take advantage of a program they don't need. A quick example of that: A few years ago a very successful woman was collecting welfare payments, foodstamps, and lived in a low income apartment. She lied about her income. Somehow it was discovered that this woman had an income of almost 6 figures and drove a brand new Mercedes. I know that was an extreme case but I was trying to get a point across.

I know I have gotten a little off topic here but I always get a little riled about when it comes to welfare. 12 years ago I was a single mother. I worked 60 hours a week until the day i gave birth. I had to go on welfare after my son was born. I stayed on welfare for 6 months and then went back to work. Could I have stayed on it longer, absolutely. But, I was fully capable of getting a job and so I did. I'm all about people in need getting help, I just think there needs to be a better system in place. My biggest pet peeve are the people who feel like the world owes them (I think WASA mentioned that). It's those people who take advantage of the system and ruin it for other people who are really in need.

Just my thoughts!

Jenn

[Ang1982 4]

When I had my consult with my surgeon back in November I asked him why BC medical didn't cover the Lapband procedure but covered the Gastric Bypass. His answer was interesting and I cannot recall everything he told me but what he did tell me made sense.

He said that like any elective surgery there is a budget that is allotted and that covering a surgery such as this will end up with only a few a year being able to be done and huge weightlists (currently like Gastric). He also said that this type of surgery would be obviously then paid to him by the govt (or something like that) and that while it's not all about the money that it's not worth their while to take on a surgery that REQUIRES immense amounts of aftercare and that you don't want any joe-blow doing them and not committing to providing the required aftercare. He said it would be more profitable for him to do govt paid gallbladder surgeries and not do any Lapband not to mention he would then not be required to do a lot of post op. He choses to these surgeries and regulate how many he does to provide his patients with the best follow up that he can (he does NOT charge HIS patients for fills at all).

I am probably leaving out a lot of what he told me as it was almost a month ago, but when he said it I was like - that makes COMPLETE sense.

[wrk-n-prgrss 0]

What about the people that will get a WLS on Medicare or Medicaid and will not be successful because they dont follow the guidelines? I have met many lap band recipients who had insurance coverage and therefore paid little out of pocket who would not be considered a success by Inamed because they lost only a small percentage if any excess weight.

[dakotasunshine 0]

I am 53 and have worked since I was 16. I was a dental hygienist for 30 years but due to health problems of mine one son and my husband we lost EVERYTHING, our home, 401K and sold everything of value, rolex,chanel, Hermes ect to try to stay out of the system but due to extreme circumstances I have lost all due to health problems. I paid and paid alot over the years, so I feel in my case I am only taking out what I worked hard for over my life. Once I get disability, which my lawyer thinks in my condition should not be a problem I will be on Medicare because I will make to much for medicaid help, which is fine by me!

[snuffy65 1]

To me this isn't a walfare issue or a "entitlement" issue. People who are on medicare or medicaid have it for medical needs. How many of us had to go through their insurance and prove that it is a medical "need" in order to get covered?

Well whether you like it or not medicare and medicaid is a type of health insurance so if YOU get covered for a medical neccessity, why can't they? If you tell them they don't need it then your insurance shouldn't have covered it either.

On a side note, I don't like the current entitlement programs our government has.

[tapshoes 2]

To quote an earlier post:

The days of the rest of the world owing others a living are coming to an end. People are fed up, they aren't taking it anymore.

I can only hope so, but frankly I don't see it. In fact, I hear more and more how people are 'owed' everything! Now yes, there are extreme cases, but not every joe/josephine on the street is 'owed' for every untoward event in their life. I have, and continue to, pay taxes etc. with the understanding that any benefits are for those in dire straights, not for a long-term lifestyle for someone otherwise capable of working. I certainly did not tally how much I paid in, with the thought that someday I would get it all back.

The cost of ill-health is high (to society and the individual), and I absolutely think we all benefit if the population is healthy and able to work. I support WLS (obviously) but do not support that taxpayers should pay for everyone. The screening should be thorough (to filter out those who are 'fudging' their comorbidities), financial state a consideration including questions such as 'what can this person REALLY pay' with real financial auditing done, the work history of the person (chances of this person going back to gainful employment), etc.

OK - now I will step back from the computer as I am sure there will be stuff thrown at me for this post.

[snuffy65 1]

I support WLS (obviously) but do not support that taxpayers should pay for everyone.

I find this funny, cause this is exactly how health insurance works. Everyone pays into health insurance and only some have to use it. I could pay thousands of dollars in my lifetime on health insurance and never use it once.

The only difference between the two is one is government ran and the other is privately ran.

[plain 12]

Medicare will probably loosen up on the requirements for being banded as more cases are viewed as "successful". If the government sees that they'll be saving money in the long run by avoiding larger weight-related health issues...they'll try to funnel people in. But that brings up the issue of "overloading" the docs.

Wheetsin has a very valid point with medicaid pts and compliance. Perhaps the LB is not the right tool for that population.

[ReadySteadyGo 8]

You know I answered no...but I think I would like to change my vote to yes.

I am self-pay. I work hard, but insurance won't cover it. I guess I am just a little tired of people who don't work getting better health care than me. I usually don't think that way I am just being negative today.

Medicare should pay for lap-band, but maybe not gastric bypass. It will save money in the long run after all, and people deserve to be healthy. I was just being jealous because noone or nothing would pay for my band.

[MacMadame 81]

It sucks to be poor enough to need Medicaid. Even if it meant my WLS was paid for, I wouldn't trade with those people. Therefore, I'm not worried that they have it "better" than me in this one area.

[plain 12]

Hmmmm...I hadn't considered that, Mac. I think you're right.