Anyone get their surgery paid by Medicare recently?

Hello all - I know that Medicare (basic plan) doesn't preauthorize anything, they say they will consider it when the bill is submitted. Has anyone gotten their claim for their weight loss surgery paid here in 2007?  Did you have to appeal?  Did your Dr. agree to help you fight it out with them, or did you agree to self pay at some point? I'd appreciate in knowing - because of SS Disability I have Medicare, then TRICARE4Life, which goes by Medicare.  It's so hard to find out anything about what's going on with Medicare.  Frustrating! Thanks! Jane in Southern MD

Hi Jane, I believe that Tammy one of the members here is going through the process of gettingher wls approved and she has medicare. Hopefully she will see this post and chime in soon. Have you picked a surgeon? Have you been to a information session yet? Best of luck in your journey!

Hello All! Cira, to answer your question - I have picked the folks at St. Agnes Hospital in Baltimore and will be going to their seminar Aug 8th. My new primary care Dr. (my previous one refused to help me with my diet) has had 12 patients go through St. Agnus and are doing great.  I've also heard that Hopkins refers some of their patients to St. Agnus if they are too high risk.  I've gone to Hopkins before and not liked it much - you see a different Dr. everytime you come, sometimes 3 or 4 (as it is a teaching hospital) and none of them seem to remember anything about you.  So I have high hopes for St. Agnes. I am on the 4th month of my physician supervised diet.  I have lost 13 pounds, but none in the last 4 weeks.  I haven't been able to stick to the diet, still have my extras, but I call in my weight every week to the dietician, write down everything I eat and in what portions and try to eat according to the dietician's plans/portions.  So we will see.  I really need to lose another 15 pounds to fit into my fall/winter clothes, so I will be trying harder as I don't expect to have the surgery until after the New Year. I have had the cardiac workup done, the sleep study (found I have mild sleep apnea and my oxygen levels drop into the 80's while asleep), my own psychiatrist does the psych workup so that's no problem, and have gotten all my providers on board willing to write letters of medical necessity when the time comes.  So I will only have a few more things to do, if St. Agnes accepts me. Thanks for asking Cira!  Hope your day is a good one - Jane

Good luck to you.  I can't even get a claim submitted until I do the 6 month diet attempt.  My research has led me to The Centers for Medicare & Medicaid services which clearly states that a six month diet attempt is not necessary to have medicare approve this procedure, as most people seeking this surgery have already made numerous attempts at weight loss.  However, the doctor I consulted with yesterday tells me that I must do yet another  six month diet attempt for medicare to pay.   I don't know who to call to confirm the guidelines.   I called 1-800-medicare, and the person I talked to was clueless. 

Yes, Medicare won't give you any idea of whether they will approve it or not "until the claim has been submitted".  I have 2 more months on the 6 month diet, I knew I wasn't going to get anywhere until I did that. Unfortunately a lot of my diet experience has been over 5 years ago.  I gave up for the longest time.  I hope that doesn't hurt me. I've heard here on this website that some of the bariatric centers have a group of people look over all of your test results, comorbidities, etc. to see if you will have a good chance of Medicare paying for your surgery.  It would be a heck of a note to have them turn you down after you had the surgery - then you would have to pay it all back. Hopefully we will hear from some others to see if Medicare has been paying - Thanks!  Jane

Someone just told me that new updated medicare guidelines as of May 27 this year do require a doctor supervised 6 months diet attempt.  So I guess I'm calling my PCP and starting another attempt. As far as medicare not doing pre-approval, I would think that the doctors/hospitals are very very careful as to which patients get surgery.  They want to be paid.  So if the doctor says it's a go, medicare is most likely going to pay for it. 

You know you can get your 6 month supervised visit with the surgeon.  Dr Von Rueden counts your first supervised visit when you go for your consultation appointment.   443-849-3779   I was required to do my 6 month visit and what made me so happy was that I was not wasting anytime.  It counted from the time I had my consult. Tammy has medicare and is gong through her 6 month supervised vist through this office too and she is almost done.  I hope she gets to see this post and chime in soon for you. Good luck!