Question:
I have a BMI of >95, and all I have is Medicare -- PLEASE HELP!
I desperately need to have WLS but cannot afford it. I know that if I don't find a way to have WLS I will die before I reach 30! Can anyone give me some advise??? — Jennifer B. (posted on April 15, 2005)
April 14, 2005
I don't know this personally but I have read on the board over and over and
over again that Medicare pays for WLS. You don't even have an approval
process to go through. You need to schedule an appointment with your PCP
then see a WLS surgeon. As long as they say it is medically necessary and
you pass the pre-op criteria, you should be on your way to surgery!
Perhaps you should post this to the main message board. I think you'll get
a lot of answers there! ~Vanessa
— Butterfly Reborn
April 15, 2005
medicare will pay, no questions asked and no preapproval. You are going to
have to call around and find a surgeon that operates on those with higher
BMI's. Don't let one or two turndowns discourage you because there are
docs that operate on higher bmi patients. Also when you start calling
around, ask if they take medicare ASSIGNMENT. This mwans they cannot
charge you more than the medicare pays. If they take medicare with no
assignment, you will have the 80/20 to deal with. With Assignment, you
will have to pay a surgeons fee of about 400. and hospital fee of 800.
These are your medicare deductibles and usually, you can make payments on
it. Medicare also will pay for all your testing. Good luck
— Delores S.
April 15, 2005
I have medicare and they are the easiest ins to pay you have no problem now
just find a surgeon and get to it. Best Wishes
— Shell G
April 15, 2005
With such a high BMI, make sure you check out the duodenal switch procedure
which has a higher average weight loss and longer term average maintenance
of weight loss -- otherwise, you may never lose enough weight to get out of
the morbid obesity range. Check out
http://www.obesityhelp.com/morbidobesity/surgtype-forums/DS/posts.html
where there are a lot of people who might be able to give you advice. Also
check out duodenalswitch.com and
health.groups.yahoo.com/group/duodenalswitch/ -- there is a wealth of
information about this lesser known, more effective and frankly easier to
live with weight loss surgery.
— [Deactivated Member]
April 15, 2005
Hi there, I had medicare and medicaid here in Iowa and my Duodenal Switch
wls was paid for totally.
I was 503 2 yrs ago and today am 325......slowly still losing. The DS was
the best choice for me and is for many others that are super
obese......check it out http://www.duodenalswitch.com
GOOD LUCK and dont give up!
HUGS HEALTH HAPPINESS~
Lisa
— Lisa Jean
April 16, 2005
I can't help with the Medicare thing, but it sounds like you've gotten some
good answers already. I just wanted to also suggest looking into Vocational
Rehab. in your state. In some areas, I've heard of people getting that to
help pay for it, as your weight is no doubt hindering your ability to work.
And I also wanted to say HANG IN THERE!!! The only way that this could
"never happen" for you is if you give up. Take it from another
high BMI postie--mine was 91 and is now down to 41. Would be lower, but I'm
actually pregnant and can't lose right now. :) This can happen for you, and
it will be a beautiful thing. Don't give up.
— christied
April 16, 2005
I am in California. I had a BMI of 39.1, but had several comorbidies. I
have mediCal...was approved in twelve days. All five of the doctor's at
LiteDemensions in Orange County accept mediCal. You would have to call
them about medicare. All they want is medical necessity, and you would
certainly qualify for that. Feel free to e-mail me with further questions
if you'd like.
— lindarodham6
April 16, 2005
I believe that Dr. Lutrzykowski in Michigan accepts Medicare. He is an
excellent surgeon and performs the Duodenal Switch. I have a friend that
he also operated on and her BMI was 108, so I know that he will help people
with high BMIs when other surgeons won't. Might be worth giving him a call
if you are able to travel. Good luck!
— MandyT
April 17, 2005
Hey Jennifer,
It is great that you are going to do this for yourself. I live in PA also
and I have medicare as my primary insurance, but I also have medicaid
(keystone mercy) as my secondary coverage. I had no problems whatsoever
being approved. I went through University of Penn hospital, and I just
needed medical necessity, which I had no problem.
My BMI was 58.4 and now I am at 29. It was the easiest approval and they
paid for my testing and everything. I only had to pay for a nutritionist
appt. I have had no problems with my insurance. So just research your
surgeon find one you trust and the rest should work out. If you need to
talk to someone just email me. Lisa lap/rny 10-23-03 340/169/??? -171lbs
dr. williams
— Lisa H.
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