BMI for Virginia Medicare and Medicaid?

[frost1 0]

Hi guys,

I have Virginia Medicare and Medicaid. I think Medicare is my primary. Anyway, is 40 BMI pretty much required by most, if not all insurance (without having co-morbidtalities listed)? My BMI is 36.

Thanks guys,

Have a fun and safe weekend.

[restricted 0]

When I google, the following turns up at a Medicare site:

Certain bariatric surgery procedures for treatment of co-morbidities associated with morbid obesity are considered reasonable and necessary under the Social Security Act (Section1862(a)(1)(A)) if the following conditions are satisfied:

1. The Medicare beneficiary: Has a body-mass index (BMI) > 35, Has at least one co-morbidity related to obesity (such as diabetes or hypertension), and Has been previously unsuccessful with medical treatment for obesity.

2. The Procedure is performed in an approved facility listed at

Bariatric Surgery on the CMS website.

[Talyn 0]

fyi:

Medicaid is your primary, Medicare is always secondary if there is any other type of insurance. In your case the state (Medicaid) is rspoinsible before the federal govt is(Medicare). You would need a prior authorization for DMAS or from your Medicaid HMO if there is one(i am a nurse analyst)