Medicare will approve Lap-Band Surgery! Approved facilities List

[stacey4870 0]

:thumbup:Hi, Im Stacey I live in Derry Nh and have Medicare as my primary and Anthem new England as a secondary, when I called Medicare, they said as they would cover the lap band as long as I fit their criteria, had a BMI of over 40 , had at least 1 health issue related to obesity, went to one of their Centers Of Excellence, and had failed attempts at other diets.

I did not have to do any special diet before surgery, just did weight watchers to loose some weight before my surgery, I am being banded on Nov 9,09 and hope that Anthem will pick up the other 20% . This was a very easy process for me and didnt need to wait for any approvals...they just booked it!

[sandralee 0]

I am on medicare and have no co pay but I was wondering if they require a medically supervised diet and for how long. Does anyone know?

[HapiCat 0]

I have a medicare replacement policy through United Healthcare. Upon coverage verification I was required to go to a Bariatric Center of Excellence, have a nutritional and psychological consult prior to submission of the request for surgery. ($334 for those two visits combined not covered because there is no DSM-IV coding)

My total out of pocket is $1,080 which is the $334 (mentioned before), $500 program fee and I believe a fill or two.

[TxRNLori 0]

I am so happy for you. I know sometimes it is difficult for Medicare patients to find a surgeon who will do their surgery. I do hate that they charged you such a large program fee. What was the "program"? We do not charge our Medicare patients a program fee. Nor do we charge any of our patients for follow up phone consultations with our Registered Dietitians. Our support groups are also provided at no cost to our patients. I am the Bariatric Coordinator for Wadley Regional Medical Center in Texarkana. Our surgeons Dr. Hekier and Dr. Keilin do NOT turn away a patient just because they have medicare nor do they limit the number per month like a lot of docs. If you qualify and you satisfy the requirements set forth by medicare you are good to go.:biggrin:

[HapiCat 0]

I am so happy for you. I know sometimes it is difficult for Medicare patients to find a surgeon who will do their surgery. I do hate that they charged you such a large program fee. What was the "program"? We do not charge our Medicare patients a program fee. Nor do we charge any of our patients for follow up phone consultations with our Registered Dietitians. Our support groups are also provided at no cost to our patients. I am the Bariatric Coordinator for Wadley Regional Medical Center in Texarkana. Our surgeons Dr. Hekier and Dr. Keilin do NOT turn away a patient just because they have medicare nor do they limit the number per month like a lot of docs. If you qualify and you satisfy the requirements set forth by medicare you are good to go.:biggrin:

The "program fee" covers all post-op visits with the psychologist, nutritionist and exercise physiologist. Support groups are free but across my state so I need to find one in my local area.

[TxRNLori 0]

Be sure to go online for support also. A lot of the docs have blog where they give support and information. I write some on our surgeons site. Check it out at Lap Band Surgery Texarkana- Serving Oklahoma, Texas, Arkansas, Louisiana

Let me know what you think.

[HapiCat 0]

Be sure to go online for support also. A lot of the docs have blog where they give support and information. I write some on our surgeons site. Check it out at LAP-BAND® Surgery Texarkana- Serving Oklahoma, Texas, Arkansas, Louisiana

Let me know what you think.

Awesome thanks!!!!

[mondk 0]

Hi. I'm on Medicare because I'm on SS Disability for bipolar disorder. I'm 37, 5'2, and weigh around 190 lbs. My BMI is 34.7!!!!!! I'm actually considering increasing my calories so I come out at 35 so Medicare will pay. I also have hypertension.

I'm attending a seminar next week and am hoping by the time of my medical consult, that my BMI is high enough. I can lose about 10 lbs. on my own but never keep it off and they just increased my B/P meds.

Would love to chat with anyone in my position!

Thanks and blessings, Michelle

[sharon_57 0]

Hi, I live in Russellville, Arkansas and I have medicare Ins. I need another Insurance that will pay what medicare won't for the Lap_band surgery. Does anyone know of any insurance that I can check into for that. I am 5ft 5in. and weight 382 lbs. I hope some one out there can help me. Thanks.

[NurseShay 24]

Hi. I'm on Medicare because I'm on SS Disability for bipolar disorder. I'm 37, 5'2, and weigh around 190 lbs. My BMI is 34.7!!!!!! I'm actually considering increasing my calories so I come out at 35 so Medicare will pay. I also have hypertension.

I'm attending a seminar next week and am hoping by the time of my medical consult, that my BMI is high enough. I can lose about 10 lbs. on my own but never keep it off and they just increased my B/P meds.

Would love to chat with anyone in my position!

Thanks and blessings, Michelle

Just beware that they expect you to have been overweight for 5yrs, be 100lbs overweight & have proof of trying to lose weight & failing. Not just your BMI is considered. Especially if your looking for full insurance coverage. Lap band is a tool & should not be a first resort to weight loss. No offense but the risks that can come with it may have you regret trying to gain weight just to fall in the parameters of for the surgery so weigh your options carefully! Best of luck to you!

[MadCurves 0]

thanks for this info- now a dumb question how do i go about finding a doctor that does the procedure at one of these approved facilities?

[susi1662 3]

I am also disabled but denied medicare because I am covered under my bf's private insurance. I know that I am still eligible though, but don't know if I can get it right now.

Since my private insurance is covering the majority of the things I need, I wonder if I have medicare, if they would help with the 5000 dollar copay I have to pay to the hospital?

[cherib2 0]

Hello !! ... I am covered for medicare through Health Net's Healthy Heart Advantage Plan..My BMI is 39% .. I believe I will not have a problem in some areas..I have been this heavy off & on for the last 20+ years..went to the MD 6 months ago and given a diet/exercise plan..joined WW.etc..The weight is aggravating severe arthritis/bone spurs in my neck and fibromyalgia..So, I am wondering what information I should present to my Dr. to get her on board and anything else I need to do..this is pretty overwhelming ! Thank you !!!

[ozarkhippymamma 0]

I have MEDICAID because I'm on SSI (i have been disabled before the age of 18 due to a genetic disorder) so I have never worked enough hours to actually have actual Medicare-- I am currently in Missouri and they paid for my lap-band surgery in June- i have a realize band in place-

There is a BIG possibility that in a few months, we (husband, daughter and i) i may be moving to WASHINGTON state to live with family. So I will be going from Missouri Medicaid to Washington's state health (I'm not sure if its called medicaid there still?) ...

Does anyone know if they will still cover my aftercare/fills? I know its hard enough to find a place that will take transfer patients as it is... but I was already covered through one state medicaid program... I just don't know.

Thanks in advance:)

[JennyHopes 0]

Hi, my name is Jen, I have been struggling with my weight my whole life.

I was approved by my private insurance (at the time) surgery done in Sept 2007 but I ended up getting very sick with a Pyelonephritis (very severe kidney infection) followed by appendicitis (apparently I had some kind of systemic infection) about a month before the surgery was going to take place.

I ended up losing the weight on my own.... but of course I gained it all back and then some.

My BMI is 35.5 and I have had 2 cervical spinal surgeries (1 in 06 and 1 in 07) and now also have 3 disc herniations in my lower back severe enough to put me on a cane, which is what really prompted me to have the lap band done in the first place, more than anything else was my chronic severe back issues. I also have bad knees, etc.

I am now on Social Security Disability and have Medicare AND medicaid. Its straight medicare.

Do you think I can get it approved?