Has anyone gotten approved by medicare...

And HOW in THE WORLD did you do it ? I cant even get passed the new patient coordinator for a consult appt. The NPC is saying that the only way to get seen is to have at least one of the three co morbidities that she mentioned..sleep apnea, diabetes or coronary artery probs. I have called medicare & they gave me a list of at least 10 co morbidities that they would approve for. Of that three I dont have any but of the 10 I have 2 possibly 3 ( pending another specialist visit) . So I emailed the NPC the website that medicare states all of these co morbidities. Hopefully Im on the right track. Anyone know of anything different or more that I can do ?    

Your best bet is to start by finding a Surgeon who accepts Medicare abd go through their Bariatric Coordinator to Medicare. They have all of the Criteria & requirements needed to proceed further.

Hi Michael, I appreciate the response. I have found a Dr that takes medicare but cant get past the new patient coordinator for an appointment. They stop me dead in my tracks when I let them know I dont have any of the 3 co morbidities they mention medicare approving. Told me theyd "hang on" to my paperwork though... in case that changes.

Interesting.

I work with Medicare patients daily at US Bariatric Orlando. According to the Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R), Medicare only requires a BMI of at least 35 with one documented comorbid condition.

I would ask your surgeon, why impose additional requirements?

You can view the decision memo at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160.

HTH,

Kristen

MY DOCTOR DOES NOT TAKE MEDICARE - BUT THEHOSPITAL DOES - DR KIM AT FLORIDA HOSPITAL -  I PAID FOR HIS SERVICES AND THE HOSPITAL FILED MY MEDICARE - BASED ON MY CO - MORBIDITIES - I HAD NO PROBLEM - I WAS ONLY 75LBS OVER WEIGHT - I FIFNANCED THE SURGEONS FEE - I KNOW THE CLEVELAND CLINIC IN FT LAUDERDALE HAS A LENDER JUST FOR THIS SERVICE - GOOD LUCK PLEASE DO NOT HESITATE TO ASK ME FOR ANY MORE INFO -

Muhammad Jawad

Ocala

(352) 351-5770

RNY, LAP-BAND®, Revision, Fobi Pouch GB

Bariatric and Laparoscopy Center of Ocala

William Overcash

Ocala

(352) 368-2828

RNY, DS/BPD, VBG, LAP-BAND®, Revision, Fobi Pouch GB, Vertical Sleeve Gastrectomy

Surgical Assoc. Of Marion County

Check with these Two Surgeon's in Ocala, Good Luck, Mike

I tried to go with Dr Jawad but they stopped taking medicare in November of 06. My appt. with him was in Oct of 06 so they didnt even see me.They cancelled the appt. I am now looking into surgery with a partner in the same office as him that does take medicare & Im stuck right where I am...again. The 10 co mirbids. to choose from is better for me b/c I dont have any of the 3 that the Dr.'s office has mentioned. ( The sleep apnea, diabetes or coranary artery probs) I have osteo-arthritis gall bladder desease and resp. probs. Those were not covered according to the lady I talked with at Jawads office ( she handles new patients for both Jawad & Shabani) . The Drs office isnt trying to impose more co mormids they are trying to limit the co mrbids that are acceptable.to  3 I dont have instead of the ones that are on the list that I do have. I called medicare & they said they ( the co morbids that I do have )  were covered so I dont know what to do next..I know this is the very first step of a long road to come so Im trying to cope but Im exhausted already !      

Ya know I got to thinkin & maybe I didnt explain the situation good enough...sorry... so here goes again...The lady at the Drs office is trying to limit coverage to JUST those 3 co morbids, when I KNOW for a fact that the others mentioned in the memo are covered. The other ones that are in the memo are the ones I need to be covered as I dont have any of the 3 she stated. I hope that makes sense to you guys. My head is spinning right now..just dont understand the ladys logic in telling me that only the 3 are covered.

You may need to search further away from home for your surgery. Such as coming to the Tampa Bay area, Orlando or Pennsacola. If not up into Georgia. Check above in the Sugeon's Section (Top Left) for a OH listing of surgeon's who have registered with OH.

Hi all, Got a call from Dr Jawads ( Shebanis) office today. Apparently everything was just a mix up as the NPC was willing & ready to scedule an appt. with Dr Shebani for next month. I let her know that I have done nothing as far as the 6 month diet or actually getting my comorbids diagnosed by the correct Drs. yet & asked if I should see Dr Shebani first or get all of my ducks in a row before I do. She suggested that I get all my ducks in a row in the 6 months that Im on the diet. She said that Dr Shebani would have to see me again for another consult at the end of the 6 months anyway so we opted to wait until Im done with all of that. I have made the appt with my PCP to get started on a diet. I also have a sleep apnea consult soon too. So thats where we go from here. Im happy to have some sort of plan now, & know that I have a professional that agrees with it too. I get a bit scared of doing things on my own, they have a tendancy to backfire..