Has anyone gotten approved by medicare...
Wow ! Im glad she came around. But I dont think it will be like that in my situation b/c I HAVE to have a letter from my PCP to move forward according to medicare. So if shes not on board then I'll have to find one that is. Maybe a medicare provider. I think Dr.s forget sometimes that they work for you not the other way around. I hope things are working out for you too. Do you have to go thru the 6 month diet too ? Or is all you have to have the PCP letter ?
There is nothing in the medicare decision that specifies a six month supervised diet. While it may be a requirement of a local medicare contractor -- it is not a medicare requirement. With the serious health issues you have you might want to discuss moving forward with the surgeon. In the last six months -- your visits with your PCP may suffice, if diet and exercise were discussed and you were weighed at each visit. Red
Ya know I JUST this am called them about that.(medicare) I told them that my surgeon says medicare needed 6 month diet history & the lady couldnt show me where it said that on medicare website "so I said so do I have to have it ?" She says "your Dr office typically knows what medicare will & will not pay for so if they are telling you that you need it then you should do it" Well if that wasnt passin the buck I dont know what is. Sooo I dont know what to do next. Should I go ahead & make the initial visit to my surgeon which will be Dr Shebani ? OR should I do the 6 month diet & call the surgeon when I get that done ?
Medicare is great for that and because there is not a pre-approval process I think the surgeons get really nervous about it. I wrote an email to the contact person listed on the Medicare Decision Memo asking specifically if the policy regarding a mandatory pre-op diet requirement had been changed since the memo was published and this was the response that I got --
"We have made no changes to the national policy on bariatric surgery. However, some of the local Medicare contractors have local coverage determinations that outline in more detail some of the requirements. The national coverage determination uses broad language when addressing the weight loss provision of the policy. This leaves the more detailed requirements to contractor discretion. I hope this helps to clear up any confusion."
Oh yes, now it is clear as mud! Go for your initial consult and talk to the surgeon. You have some very serious health issues that could be much worse in six months. He may not be willing or able to waive the requirement but if it were me I would certainly take a shot at it.
Red
Edited to add:
But when you go to see the surgeon take him a diet history. A diet history is very different from a supervised diet. On the diet history list all of the diets you have ever been on, the approximate dates, and the outcome. Also go to the appointment armed with a letter from your PCP or other physicians that show you have been under their care and that you have discussed diet, exercise and nutrition during your routine office visits. Again this is not the same as a supervised diet -- but since the jury is out on whether that is a requirement of Medicare you might just give the surgeon enough anecdotal information that he will be confident to go forward.
"We have made no changes to the national policy on bariatric surgery. However, some of the local Medicare contractors have local coverage determinations that outline in more detail some of the requirements. The national coverage determination uses broad language when addressing the weight loss provision of the policy. This leaves the more detailed requirements to contractor discretion. I hope this helps to clear up any confusion."
Oh yes, now it is clear as mud! Go for your initial consult and talk to the surgeon. You have some very serious health issues that could be much worse in six months. He may not be willing or able to waive the requirement but if it were me I would certainly take a shot at it.
Red
Edited to add:
But when you go to see the surgeon take him a diet history. A diet history is very different from a supervised diet. On the diet history list all of the diets you have ever been on, the approximate dates, and the outcome. Also go to the appointment armed with a letter from your PCP or other physicians that show you have been under their care and that you have discussed diet, exercise and nutrition during your routine office visits. Again this is not the same as a supervised diet -- but since the jury is out on whether that is a requirement of Medicare you might just give the surgeon enough anecdotal information that he will be confident to go forward.
Hi Red & thank you very much for doing all that for me. I really appreciate it. I am going to call & ask for the initai consult even though I may have to do another one at the end of the 6 months .I just got an email from NPC telling me the Dr might not even DO a surgery on me. Might not think Im a "canidate" ...Well Im SURE not goin thru 6 months of a diet plan ONLY to find out Im not a "canidate" I dont understand why anyone would think I would either. Thats just setting yourself up in my opinion. So..If I have to pay the consult fee before I start the diet AND after I have to. Its worth it to get everything on the table ya know. What a crabby mood Im in right now. Just crabby ! Sorry !
HI all, Finally made the decision to do the inital consult then the 6 month diet So I will not have to stress so much on alot of different things,Mostlt IF my surgeon even thinks I am a canidate for WLS.I just didnt want to set myself up emotionally for a big crash after doing the 6 months.My consult appt. was made this am for July 16th I am ready to get the ball rolling !
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