Lap-band surgery and medicare

June 6, 2005

I am researching having the lap-band surgery done but am on Medicare. Has anyone had medicare approve this procedure?

the best me · June 6, 2005

ooooo, ooooo, good question. My dad is on Medicare, I am fairly certain it pays for banding, but how much does it end up being out-of-pocket? That was his question. If Medicare pays for ALL of it, he might consider it. He's around 275, age 66 and REALLY needs to take off the weight. I'm anxoius for replies, too!

coyotegirl · June 6, 2005

YES, Medicare paid for my band! Not all but a very good portion of it. I had NO problem getting approved and they have not turned down anything. Not even my fills.

Out of my pocket I have paid about $1,000. Not all at once but 20 here or 20 there.

I am on Medicare because of a spinal disability.

rene2005 · June 8, 2005

Hi Do you know what medicares requirement is? BMI? Docmumentaion of diet?? Extra diseases like diabetes??

tHANKS

jqpublic · June 9, 2005

I called Medicare for two weeks streight evry ten minutes it seemed to they gave me this answer this is for wi they would only pay for Gastric by pass and the Roux-en-y only

also had to go see a shrink Docter for your head also six mounth of monitored weight loss with your docter or diet technician and have a bmi over 40 or other health factors.

Good luck Keep on trying every case is different/he who crys the loudest gets heard.

rene2005 · June 9, 2005

HI thanks for all the replys. I called to today and she said that my dr would know how to send in the paperwork to get it covered.

All I know is that medicare a few months ago took the wording OUT of the "policy" stating that obesity isn't considered disease. I think I will call obesity clinic that do the surgery and ask them!?

Thanks,

Rene

coyotegirl · June 9, 2005

Wow I really don't know what Medicare's requirements are. I went with my Dr.'s requirements and didn't really think about Medicare's. I quess my Dr. and Medicare have the same requirements because I was aproved right away.

BMI 40 or over or 2 other health factors.

documentation on ALL diets I have been on for as far back as I can remember, how much I lost on those diets and how much I gained back. (ALL)

I did not have a 6 month monitored weight loss with a Dr.

I had to go to large group seminars and then small group ones.

Yes I had to see a shrink (only one time)

Then one appt. with a nutritionest.

I think that was about it other than all the pre-op testing.

Good luck, I hope this helps.