MEDICARE PROPOSES NEW COVERAGE POLICY FOR BARIATRIC SURGERY PROCEDURES

MEDICARE PROPOSES NEW COVERAGE POLICY FOR BARIATRIC SURGERY PROCEDURES On November 23rd, 2005, The Centers for Medicare and Medicaid Services (CMS) proposed national coverage for Medicare beneficiaries under age 65 for open and laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding under certain clinical cir****tances and when performed in a facility meeting evidence-based standards for bariatric surgery. For the full story, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1733 Here is a chronology of what has happened up until now. July 2004 Medicare removed language that said obesity is not a disease Nov 4, 2004 A Medicare Coverage Advisory Committee meeting was held to review evidence related to the benefits, risks and costs of bariatric surgery in obesity. Feb 7, 2005 CMS posted a transcript of the meeting Nov 23, 2005 Medicare proposes coverage Why This Is Important Traditionally, what Medicare decides to cover has a powerful ripple effect through the federal-state Medicaid program and in private, commercial insurance. Medicare endorsement has a powerful effect on all payers in the health care system. So even if someone is not a Medicare patient, they may potentially benefit!! Medicare is accepting public comments about the national coverage of bariatric surgery for Medicare patients under the age of 65. . Now is your chance to show your support. Tell the government how much you have been helped by weight loss surgery. You have until Dec. 23rd to send an email to: [email protected] Tell her how your life has changed, how your co-morbidities have disappeared or just tell her that you have had the surgery, are successful and support the Medicare proposal. For an excellent guide on how to respond to Medicare, visit the Obesity Action Coalition Website. http://www.obesityaction.org/advocacy/medicare.php On that page is a link to "A Patient's Guide to Advocating for Improved Access to Weight-Loss Surgery Under Medicare." This publication will guide you through formulating a response. For the sake of all of those who are struggling to obtain insurance Coverage, do it today!!!

Please let your elected officials and medicare know how your procedure has changed your life for the positive and that it should be covered. I feel the type of surgery to be performed should be decided by the patient and the doctor. Once medicare makes the change- private insurance companies will follow thier lead. Comments to: http://www.cms.hhs.gov/mcd/public_comment.asp?nca_id=160&basketitem= Also send a note to your Senator, Representative and President: http://mygov.governmentguide.com/mygov/home/ here is what Medicare has to say: "The evidence is not adequate to conclude that the following bariatric surgery procedures are reasonable and necessary and they are therefore non-covered for ALL Medicare beneficiaries: open vertical banded gastroplasty, laparoscopic vertical banded gastroplasty, open sleeve gastrectomy, laparoscopic sleeve gastrectomy, open adjustable gastric banding, open biliopancreatic diversion with or without duodenal switch, and laparoscopic biliopancreatic diversion with or without duodenal switch. The two non-coverage determinations in the National Coverage Determination Manual (NCDM) remain unchanged: Gastric Balloon (NCDM Section 100.11) and Intestinal Bypass (NCDM Section 100.8). " Source: Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R) *** While the procedures above are not the most popular the decision on which procedure would be the most medically appropriate for the patient should be between the patient and doctor. I personally want to have the duodenal switch procedure. And my doctor is in agreement. Please oppose medicare not allowing medically proven procedures like the open biliopancreatic diversion with or without duodenal switch, and laparoscopic biliopancreatic diversion with or without duodenal switch. I believe the other procedures have thier specific place in the treatment of specific patients***

Hi there! I am new to all of this and hoping to get LapBand surgery but can not find any info anywhere regarding the process in which to follow under Medicaid. I'm finding lots of information regarding Medicare but I am only 35 yrs and not really willing to wait until my golden years to qualify for Medicare...lol. ...besides the reason that I qualify for Medicaid at this point in time is due to the fact that I am a full time student so I was hoping to get it done while I was still in school and still eligible for Medicaid. I was wondering if you might have any information regarding WLS and Medicaid to share? Can you point me in the right direction? Thanks a bunch! Gina- Los Alamos, NM :help: