Lap Banding and Medicare

[toomuchsusie59 0]

Hello Bandsters...

I have a few questions for you, if you don't mind answering them.

1. Was your surgery paid for by Medicare?

2. Did you have any problems getting approved by Medicare?

3. Did Medicare require the 6 wk pre-surgery diet?:thumbup:

4. Was your surgery date faster with Medicare?:cursing:

I am waiting for my "doctor of choice" and the hospital to be approved by Medicare. I am not worried about being approved for surgery, because I have all of the "conditions" for the lap band (ie: many medical conditions like heart disease, diabetes, hypertension, etc.). I am 5'8 and weigh 270 with a BMI of 41, and have been obese all of my life with no luck with any type of diet I've been on. Lose some weight, give up, gain it all back plus more.

Any answers would be very much appreciated.

[sfeiner 2]

Hi Susie,

1 Yes medicare paid for my surgery and also pays for the fills and any other aftercare I need. My supplemental ins. is AARP and they pick up what medicare doesn't pay. I have never seen a bill.

2. No problem at all.

3 no they didn't require any 6 mos diet. The Dr required a 2 week pre- surg diet.

4. Well the Dr doesnt schedule until they get ins. approval and that came right away but it still took 6 mos to get all the pre-testing done.

Hope that helps.

[lee41 0]

Yes, my surgery was pretty well covered by Medicare. I was very pleased with their coverage. But, I think that whether Medicare will pay, and how much they pay, depends upon the Medicare Plan you signed up for. My plan is through Secure Horizons which is absolutely great. Whether Medicare pays will, I think, depend upon whether your doctor is an approved doctor and if the surgery is done in a center of excellence. I did not have to go on a 6-week pre-op diet, only the 2-week pre-op diet required by my doctor. Question: I notice that you are 59 years old. Are you old enough for medicare?

[toomuchsusie59 0]

Yes, my surgery was pretty well covered by Medicare. I was very pleased with their coverage. But, I think that whether Medicare will pay, and how much they pay, depends upon the Medicare Plan you signed up for. My plan is through Secure Horizons which is absolutely great. Whether Medicare pays will, I think, depend upon whether your doctor is an approved doctor and if the surgery is done in a center of excellence. I did not have to go on a 6-week pre-op diet, only the 2-week pre-op diet required by my doctor. Question: I notice that you are 59 years old. Are you old enough for medicare?

Thank you for your reply. No, I am not old enough yet for Medicare. I am on Social Security Disability because of all of my medical problems. I had a triple heart bypass 3 years ago and haveType 2 Diabetes, hypertension and high cholesterol. Because of breathing problems, temperature extreme intolerances, and being on blood thinners for the rest of my life, I am not able to do the type of work I did (piece work in a factory) before.

Susie

[toomuchsusie59 0]

Hi Susie,

1 Yes medicare paid for my surgery and also pays for the fills and any other aftercare I need. My supplemental ins. is AARP and they pick up what medicare doesn't pay. I have never seen a bill.

2. No problem at all.

3 no they didn't require any 6 mos diet. The Dr required a 2 week pre- surg diet.

4. Well the Dr doesnt schedule until they get ins. approval and that came right away but it still took 6 mos to get all the pre-testing done.

Hope that helps.

Yes, your reply did help answer my questions, Sharon. Thank you for your quick response.

Susie

[sharon160 0]

Yes medicare and aarp paid for my surgery (well, they will, haven't done it yet, but I'm only 3 weeks out)

No 6 month diet requirement.

The biggest problem I had was the original center i went to had a 3 year waiting list for medicare patients, as they only took 2 per month. I had to go to another center of excellance 400 miles away to get surgery. Took 3 months for all the pre op stuff and when that was all done, they wanted to do the surgery the next week. Took us another 3 weeks to get the trip all organized and the snow to stop so we could travel.

[JoannMarie 0]

I've been interested in this thread because I am also a Medicare patient - kinda mid-point in my research. There are several facilities in my area (Kansas City) that are receiving their certification as Centers of Excellence, but Medicare seems to be pretty slow to get all their paperwork done and billing codes established, etc. Unfortunately, I am not always very patient with crossing the t's and dotting the i's... At any rate, I am considering going to Topeka for my surgery - about 160 miles round trip. My question for Sharon - do you have to go on your 400 mile trip for all your followup, fills, support group, etc, or can you get that done (and covered) locally? I am attending all the local COE seminars in hopes of doing all this locally with a center I am comfortable with. Headed for Topeka this weekend to discuss their program at their seminar.

Another thing I am finding -- the docs at some of the COE's do not accept the Medicare assignment. In other words, if Medicare pays $900 and the doc's charge $5000, I would owe the doc $4100. Is this what others are finding? That's out of my league, and would be for many Medicare folks I know. My supplemental ins would help, but I don't know if it would pay enough to make the doc happy. The hospital facilities are accepting the Medicare assignment so that does not seem to be the problem.

Ever hopeful,

Joann:huh2:

[GaLina 0]

I've been interested in this thread because I am also a Medicare patient - kinda mid-point in my research. There are several facilities in my area (Kansas City) that are receiving their certification as Centers of Excellence, but Medicare seems to be pretty slow to get all their paperwork done and billing codes established, etc. Unfortunately, I am not always very patient with crossing the t's and dotting the i's... At any rate, I am considering going to Topeka for my surgery - about 160 miles round trip. My question for Sharon - do you have to go on your 400 mile trip for all your followup, fills, support group, etc, or can you get that done (and covered) locally? I am attending all the local COE seminars in hopes of doing all this locally with a center I am comfortable with. Headed for Topeka this weekend to discuss their program at their seminar.

Another thing I am finding -- the docs at some of the COE's do not accept the Medicare assignment. In other words, if Medicare pays $900 and the doc's charge $5000, I would owe the doc $4100. Is this what others are finding? That's out of my league, and would be for many Medicare folks I know. My supplemental ins would help, but I don't know if it would pay enough to make the doc happy. The hospital facilities are accepting the Medicare assignment so that does not seem to be the problem.

Ever hopeful,

Joann:huh2:

JoannMarie, Boy am I glad I read your post.:thumbup: I did go on the internet and checked out the hospital and it does have Medicare seal of approval but I haven't checked to see if the dr.:w00t: that I have chosen will accept Medicare. I guess I have more investigation to do.

Oh, I haven't had my appt. with the surgeon yet. Just my PP and she has sent all of the paperwork to the surgeon as of yesterday. I am also on medicaid and I call to check out if they would cover what medicare didn't and they said that they did. Hope all goes well with you and I will keep checking in to see what happens. Keep us posted, ok. I don't often reply but I do read the post. My prayers will be with you.

[sharon160 0]

JOann: I'm going to do the 400 mile trip (by plane of course). Since Medicare will cover my fills, it will cost me 148 to fly down there, and stay with family who will transport me (or loan me a car). I just feel better staying with my surgeon whom I totally adore. I didn't even check with the local bariatric group since so many on the lists have said you can't change doctors for you fills, unless you go to Fill Center USA. One of those are opening about 150 miles away, but for now (I'm only 3 weeks out) would rather stay with my surgeon.

I'm not sure, but be ve;ry careful what you sign ...I don't believe the surgeon can come back on you for the difference. I think it is a "rule" of medicare. My medicare statement came thru today for the hospital. and anithesiologist and both said I would be billed 0.00 even tho they discounted the bills from 37,000 to about 12,000. I don't have the doctor's bill yet, but he assured me.......

[JoannMarie 0]

Thanks, Sharon and Sallie for your responses.

Sharon, your weight loss already is amazing! When I read posts like yours I am so encouraged...

I should clarify the COE I am talking with was very upfront about their surgeons not being contracted with Medicare, therefore charging their usual charge for this surgery. I know if they are contracted with Medicare they cannot charge you more than Medicare will pay. The center also said (and it is in their written communication) they will accept what Medicare AND MediGAP supplement will pay. I will check that out further and talk to my ins agent about the right kind of supplement. The other COE I am visiting indicated they have 3 surgeons who are contracted with Medicare, so there would be no further charges for the doc. I have been told the Medicare requirements and approvals are easier to obtain than many insurances. The trick is finding a COE with Medicare docs convenient to your home.

This will be SO WORTH IT!

Stay positive,

Joann

[sharon160 0]

Thanks for the kudos on my weight loss. This is a person who lost 6 lbs before surgery from Sept to Jan, and then gained back 3 just before surgery. You may notice the turtle. Apt avatar, cuz I still think I will be a turtle at this. I've ALWAYS lost very very very slowly. I can't believe this loss in the last 3 weeks. It's actualy faster than I would like, but I'll take it for now and a fast start off the starting line.

thanks

[maggiehpp 0]

Hi Sharon,

Maybe you can help me with a couple of questions: Does Medicare pre-approve the surgery? Seems like I read on here a few months ago that they do not pre-approve, but usually pay. Also, that Medicare does not pay if you do not stay overnight at the hospital. It's been awhile, so maybe my memory is not correct. I have been going to my pcp for about 7 mos. for dr. supervised diet, and am preparing now to call the surgeon's office and see what my next step is. Any help would be appreciated.

thanks,

markie

[sfeiner 2]

Hi Markie, You didn't say which sharon you were addressing (there are at least 3 of us) but I will answer. Yes, they pre approved surgery. I don't know about the overnight stay. My Dr said that I might go home the same day but He would see how I did after surgery. I don't think he would say that if he knew medicare wouldn't pay....and he is very up on insurance and medicare. He runs the support group for the bariatric clinic and I've heard him answer hundreds of insurance questions. Anyway I had to stay because of low 02 levels so I'm not 100% sure Also I don't believe medicare requires the 6 mos diet but maybe your surgeon does. Hope I've been some help with my wishy washy answers. :crying:

[Genea 0]

Hi Markie,

Medicare took care of my surgery and yes you have to stay overnight. You also have to be in a COE, do some other required things.

Good Luck, it is worth it.

Gene

[JoannMarie 0]

Hi All,

I am really glad to be on this search, because I have certainly learned alot about supplemental insurances. The plan I have states it pays excess physician charges - come to find out they have their own method, and I have been told by the company rep and the agent they figure things a bit differently. I just spoke with a different company got a different story - they DO pay 100% of excess physician charges. I'm beginning to feel I am not getting a straight answer from anyone. I'm waiting for a call back from the COE rep to ask her what their experience is. I'll switch plans - which I am now inclined to do anyway, considering the run-around I'm getting from the current company. It's good to hear the rest of you have had good luck with your Medicare and supplement coverage. I know I'll get there too. I'm just glad to be researching this now before I waste more money on a plan that does not pay what I have been told they pay.

Good luck on your journeys!

Joann