They said Medicare Wont Pay Because....

They said they won't pay because effective immediately that the surgery center must be covered procedures for weight loss surgery may on ly be performed in facilities that are certified by the american college of surgeons as a level one bariatric surgery center or certified by the american society for bariatric surgery as a bariatric surgery center of excellence and this was mandated on february 21st neither of the hosptials in delaware have this certification at this time . Help me please!! My surgery is scheduled for March 6 and they are cancelling it! Please tell me what to do!

Call BARIX 267-572-3100, Langhorne PA one hour away. they have those qualifications

PA Hospital of Phila has those credentials as well. What I would suggest is to start shopping around the area. My surgeon only does RNY open but he does have a partner that does Lap RNY and Lap Bands. Not sure of the wait to get seen but hey it doesn't hurt to call and get details. Sorry to hear about Medicares new guidelines. Debbie

I would call Medicare to find out what hospitals and Surgeons are on their list for coverage. Explain your situation and see what someone at Medicare can do for you. All of your Pre-op testing can be transfered if need be. I wish you well.... Sharon ObesityHelp Leader

Tonya...do you have Medicare or Medicaid? I was just curious. I have Meidcaid with DPCI and aso far they haven't said anything. It seems as though the would have given you or Mistee some forewarning! I feel terrible for you and my thoughts are with you. I would still contact Medicare and see if someone can help. They have more flexibiity than they let on especially since you are already scheduled. Did you already have their clearance or are you just submitting now? If you already had clearance that may help you as well. Good luck!

This was on the main board: On February 15, 2006 CMS (the people that administer Medicare) issued a new ruling on RNY. RNY is about the only approved bariatric procedure (no VBG, no banding, etc.). The new rule requires that you have the surgery at a facility that is certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center AND is certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (BSCOE). Unfortunately this ruling disqualifies a large percentage of facilities that have been providing RNY surgeries. For example in my state we went from 7 Medicare approved surgery centers for RNY to zero. The application and approval process for ACS and BSCOE is a tedious and lenghty one. You can read the summary of the ruling here: https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160 -