Has anyone gotten approved by medicare...

I am sure the time will go by fast. I mean Christmas is right around the corner. So we will cross our fingers come January and hope they give you no problems.

Thanks for the vote of confinence Eli ! I'll start my journal now & keep my blogs from start to finish. Im really excited.

It really sucks that some insurances require one thing and another insurance requires another.  I am all for the all getting together and making a decision together.  Right now if I had to wait 6 months, I would have to pay out of pocket now and not use my insurance. Is your health declining at all?

I think I mentioned that I have been trying for this ( a consult appt) since November of last year but had to find a Dr that took medicare so my health has been declining since before then. I had my little toe amputated b/c of a pressure ulcer (caused by weight) on the bottom of my foot that got infected so bad  it wouldnt heal & turned into osteomylitis ( bone infection) My osteo-arthritis is crazy bad. I have to take a lortab at night to sleep b/c of the pain on my bones. And my respiratory system sux. I cant walk 30 ft Id say before I really have to sit down. I had a car wreck in 2002 I have rods pins & screws from my pelvis to my ankles and left me unable to excersise alot. But now with all of this weight & pain  I just want to sit on the couch & watch tv. Im in the process of getting our pool resurfaced & then I'll be able to do exsercise in the pool. Im really excited about that too.

The problem with Medicare is that they publish that they will approve and pay for WLS but they do not issue pre-certification like managed care companies do.  So patients and surgeons have to do the best they can, document like mad, submit for payment and then keep their fingers crossed.  It's tough to get Medicare to pay for WLS and that's why there are so few surgeons that accept it as a covered insurance. When you do the 6 month physician supervised diet thing, be sure you go each and every month faithfully at the same time of the month and do not deviate!  Make sure they put notes in the office notes and feel free to borrow either of the letters in my profile if you think they will help. Good luck!

You might want to try The Obesity Center at North Florida Regional Hospital in Gainesville. I don't know if they take Medicare or not,but it's worth a try. Once I'm approved,Dr. Hipp will do mine. He is a great guy.

Oh my my my. You would think they would see that you need this sooner and do some sort or medical exemption to have it done sooner. Is your PCP on your side about the surgery?  I would push your primary care to call medicare and see if there is anything they can do to get this ball rolling alittle faster. Or ask for a case manager at medicare.  This is just horrible and sad.

Hello, YES,  my friend had her surg in April and is doing very well!   She lives here in Florida and went to the Pasadena hospital.  Her Dr. is very nice as was everyone we have come in contact with.  I was told it took 18 months of Dr. visits  to show she was working on weight loss, and it had to be visits every month.  Her Dr's wrote letters to help her. Best of luck to you, I know how happy everyone is after it is all done.  Julie

Thanks for the offer on the letters Jan I just might do that. Eli as for my PCP being on my side ...Im not quite sure...I will be discussing that further on the 25 when I go in for the diet plan. She is not a medicare provider so really wants nothing to do with helping me on that end. She has reccomended the weight loss drugs but I dont want to take them b/c I already have trouble with periphial (sp?) nerve damage & the weight loss drugs keep them too stimulated. I take neurontin for that every 8 hours of every day. So she refers me to a PT type of wight loss program here called Physicians Choice Weight Loss Program, BC/BS wouldnt pick up the cost of it after Medicare did their part so I opted out of that b/c I didnt feel it was kool that I have 2 insurances & cant even get anything fully paid for. We pay for both insurances mind you. BC/BS said they wouldnt pay for it b/c I have exhausted my PT allowances for life with the PT I had after my crash. What a crock ! I guess I'll just have to let my PCP know that Im going to do this no matter what & if she wants to help fine if not I'll find another Dr. I dont really want to shes been my Dr for about 15 years. But hey I gotta do what I gotta do.  Medicare says they'll pay & then doesnt ? Or does it just take them forever ? Has anyone here ever gotten stuck paying after they submitted to medicare & they denied it I wonder ? Man that would suck !

Yesterday I had the most difficult visit with my PCP ever.  I had called them on friday to let them know that when I was to come in for my visit yesterday, to have my medical necessity letter ready. So I go in and see her and we talk about all my health issues and I finally bring up about the letter. She tells me that she is not a proponent of WLS, and thinks that I can do it all on my own, that I do not need surgery. I just about flipped.  I started crying and telling her that it seemed that was her personal opinion, not medical opinion. I told her that when you have a neurological disease like I do that when you go to the neuro-opth and they tell you you will lose your eyesight in 1 year, I do not really care whether she thinks I am a candidate for the surgery or not, I am getting it with or without her. I told her there was no way in hell I was geting a shunt placed in my head if I can have this instead.  I already had two other letters from 2 other physicans that said I should get it.  Consulting her was just a courtesy.  I felt like I stopped her right in her tracks because she started tearing up and told me ok, pick up the letter tomorrow. I went this morning and it was ready for me. I think I really affected her in a way no other patient has, and hopefully changed her way of thinking.