Proximal RNY revision
I had a proximal RNY 10/13/03. I'm looking to get a revision to an extended RNY as I've gained back 80 pounds. My BMI is 31. Does anyone know if Medicare will pay for a revision? I had Kasier insurance in Northern California when I had my original RNY.
Thanks,
Maryalida
Holdenville, OK
Proxiaml RNY 10/13/03
280/140/210
Thanks,
Maryalida
Holdenville, OK
Proxiaml RNY 10/13/03
280/140/210
Hey Maryalida,
I am also on Medicare and in process of seeking revision from vertical banding to rny. Medicare does cover revisions but you have to meet certain criteria. The criteria, I can't find the list that the doctors office gave me, but I'll try to remember all of them(but please don't hold it against me if I forget one of them):
1) BMI of 35 with co-morbidities, such as diabetes, hypertension(high blood pressure), sleep apnea, can't remember others
2) Surgery has to be done in facility that is center of excellence
3) psychological evaluation
4) 4 months of primary physician supervised diet history
5) nutritional education(class)
I think there is a couple of others, but the best thing to do is call medicare and ask them for the guidelines. The problem will be finding a physician that does revisions and accepts Medicare, find a facility that is center of excellence both.
I live in Valdosta, GA and was seeing a provider in St Augustine, FL and all I had left to do was the nutrition class and then have the surgery, when the facility(it is a center of excellence) decided that they would not take Medicare primary for revisions, doctors office doesn't know why but it is something about reimbursement. So now I have an appointment with a provider that is 4 1/2 hours away from where I live, because that is the next closest provider that I could find that does both revisions and accepts Medicare.
Also, Medicare will not pre-approve the surgery, you have to do all the criteria then have the surgery done then when the doctor and facility file the claim they submit the criteria for review then Medicare decides whether or not to pay for the surgery.
I hope this helps.
Dorothy(southerngeorgiagirl)
I am also on Medicare and in process of seeking revision from vertical banding to rny. Medicare does cover revisions but you have to meet certain criteria. The criteria, I can't find the list that the doctors office gave me, but I'll try to remember all of them(but please don't hold it against me if I forget one of them):
1) BMI of 35 with co-morbidities, such as diabetes, hypertension(high blood pressure), sleep apnea, can't remember others
2) Surgery has to be done in facility that is center of excellence
3) psychological evaluation
4) 4 months of primary physician supervised diet history
5) nutritional education(class)
I think there is a couple of others, but the best thing to do is call medicare and ask them for the guidelines. The problem will be finding a physician that does revisions and accepts Medicare, find a facility that is center of excellence both.
I live in Valdosta, GA and was seeing a provider in St Augustine, FL and all I had left to do was the nutrition class and then have the surgery, when the facility(it is a center of excellence) decided that they would not take Medicare primary for revisions, doctors office doesn't know why but it is something about reimbursement. So now I have an appointment with a provider that is 4 1/2 hours away from where I live, because that is the next closest provider that I could find that does both revisions and accepts Medicare.
Also, Medicare will not pre-approve the surgery, you have to do all the criteria then have the surgery done then when the doctor and facility file the claim they submit the criteria for review then Medicare decides whether or not to pay for the surgery.
I hope this helps.
Dorothy(southerngeorgiagirl)
Maryalida,
I seen Dr Nye in Pensacola today to discuss the revision. According to them, some of the requirements for Medicare is different from what the provider in St Augustine told me. According to his office, you have to have 6 months of primary physician supervised diet history, a nutritional evaluation(different from nutrition class which you still have to have), and 5 years worth of weight records from your primary physician.
Dorothy(southerngeorgiagirl)
I seen Dr Nye in Pensacola today to discuss the revision. According to them, some of the requirements for Medicare is different from what the provider in St Augustine told me. According to his office, you have to have 6 months of primary physician supervised diet history, a nutritional evaluation(different from nutrition class which you still have to have), and 5 years worth of weight records from your primary physician.
Dorothy(southerngeorgiagirl)
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