MEDICAID AND MEDICARE SURGEONS LIST!

Hello Members,

On a daily basis we get calls from members in desperate need of surgeons that will accept Medicaid and or Medicare for Bariatric surgery.  It breaks our hearts when we have to say "we don't know of any surgeons in your state we can refer you to". 

Can you please help us? If you know of any surgeons in your state that accepts Medicaid and or Medicare, will you list their:

Name

If they accept Medicare and or Medicaid

Phone number

Facility

Address

This list will remain here for our members to access and use.

Thank you so much!!!

ObesityHelp,

Member Services

i'm on medicare, and Dr. Deveney at OHSU did my surgery.  He is at OHSU.  He comes highly recommended.  I loved the hospital and Dr. Deveney and his staff.  I felt in good hands and have excellent care.  In the end, I think I owed less than 900 dollars.  It was the best 900 dollars I have ever spent in my life!  Hope this is helpful information!

Drs. Clifford Deveney, Robert O'Rourke, and Bruce Wolfe Oregon Health and Science University (OHSU) Surgical Weight Reduction Program Digestive Health Center 3303 SW Bond St. CH6D Portland, OR 97239 503-494-1424 800-222-6478 x-1424 503-418-4189 (fax) E-Mail:  [email protected] URL: http://www.ohsu.edu/health/page.cfm?id=10085 OHSU accepts Medicare and the Oregon Health Plan (OHP). Medicare covers Duodenal Switch, RNY, and gastric lap band. OHP does not cover any WLS as a matter of policy. OHSU is a Center of Excellence for Medicare and BCBS for PEBB.

Question:

Did they tell you what the guidelines where for the surgery?


BMI
Do you have to have diabetes? Any info would be great!

Medicare covers the following: - BPD/DS aka DS (Biliopancreatic Diversion with Duodenal Switch) (lap and open) - RNY (Roux-en-Y Gastric Bypass) (lap and open) - AGB aka Lap-Band (Adjustable Gastric Banding) (lap only)

Each procedure must be performed in Medicare-approved (as in Center of Excellence) facilities.  For a listing of them, click on this link: http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage

Medicare does not cover the following: - VSG (Vertical Sleeve Gastrectomy) (lap and open) - VBG (Vertical Gastric Banding) - AGB aka Lap-Band (Adjustable Gastric Banding) (open only) - Gastric Balloon - Intestinal Bypass

As for revisions, Medicare covers open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB) and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) if certain criteria are met and the procedure is performed in an approved facility.

Source: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=100.1&ncd_version=2&basket=ncd%3A100%2E1%3A2%3ABariatric+Surgery+for+Treatment+of+Morbid+Obesity Medicare does not pre-authorize any medical services that are considered "medically necessary".  For WLS, "medical necessity" is defined as follows: BMI of 40 WITHOUT any co-morbidities BMI of 35 WITH at least one serious co-morbidity (such as hypertension [high blood pressure], heart disease, diabetes (Type 2), and sleep apnea) Hope this helps!

Hi again,

My goodness, I have been struggling so bad with this. I just recently heard that OHP or Medicare would be covering the gastric bypass or lap band procedure. I know that there are certain guidelines that you have to have to qualify. Where I'm really confused and stressed is do you have to have 1 or all to qualify for this surgery if you have Oregon Health Plan?

Is there a list saying what you have to have, or is there only one or two things that you have to have? Like diabetes OR hypertension?

My doctor thought you had to have EVERYTHING that they list? If you could be of a blessing and help me figure this out, that would be great.

Take a look at my obesity help profile and you can see what I have been through with these doctors!

I checked OHP's prioritized list of health services that was effective April 1, 2008.  WLS is covered under line 33 only when the co-morbidity is Type 2 Diabetes and the BMI is 35 or more.  Those without this co-morbidity are still considered far lower in priority under line 608 of the same list and are therefore not covered under the OHP.  Here is the link: http://www.oregon.gov/OHPPR/HSC/docs/Apr08Plist.pdf According to the OHSU website, OHSU still considers surgery for treatment of obesity as "below the line" for OHP.

So basically just because I don't have Type 2 Diabetes they won't cover me. I have everything else, but that. It so silly anymore. They would deny me right away because I don't have it. Goodness Gracious.
I need a miracle! I have exhausted all my options. With insurance companies, with getting personal financing and or a loan. Why so hard?

Is there anything else that might help me? I saw Doc. Tersigni in Coos-Bay. I paid for my consult. That was the best thing that I have could done. Now, I just see myself getting deeper into a black whole sinking and not coming up!

Here is a list of businesses that help with financing of bariatric surgery:

http://www.medicredit.com/ http://www.p-f-s.com/ http://www.cogentfinancialgroup.com/ http://www.capitalonehealthcarefinance.com/ http://www.citerrafinancial.com/ http://www.mymedicalfinancing.com/ http://www.surgeryloans.com/ Hope this helps!

Thanks for the good tips. I have tried. Unfortunately my credit is not that well. That is why I feel like I have hit a black hole deep down. Why, due to past medical bills due to my situation of being over weight. They just kept piling up and I just got depressed and couldn't do it anymore. I just can't. I have prayed and prayed for a miracle to happen. I was watching GOD TV the revival the other day. Well it is on this whole week about healing, and prayers getting answered. I sent a prayer request in. It is something massive that is happening over the world. I just have to keep faith in that and GOD will provide it for me.

Thanks
Good Luck! Hope all goes well. Not to much longer for you!