Insurance Question

Has anybody out there had weight loss surgery - lap band or gastric bypass - that was covered by a new Medicare Advantage plan called the Any, Any, Any plan. I am trying to find out what they covered. I cannot get any information from the company. Everyone I talk to gives me another answer. Medicare requires that the surgery be done in a hospital (not an outpatient surgery center) and that the patient stay overnight.. The insurance I am concerned about is offerred in South Carolina and also in Florida. There are other states, but I am not sure which ones. Many thanks for any help. You may respond to [email protected] Good luck to all, Sheila

almost all plans that are medicare replacements follow the same rules as medicare.... so I would go to the CMS website and check out the medicare rules on WLS.

http://www.univhc.com/sobs/SC/SC2.asp page 36 of 39

Indications and Limitations of Coverage B. Nationally Covered Indications Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index >35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. These procedures are only covered when performed at facilities that are: (1) certified by the American College of Surgeons as a Level 1 BARIATRIC Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for BARIATRIC Surgery as a BARIATRIC Surgery Center of Excellence (program standards and requirements in effect on February 15, 2006). 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

Hi - I would like to thank everyone that responded to my question about weight loss surgery. The question is not whether or not medicare will pay for the surgery. Their rules show that weight loss surgery is covered by medicare under certain conditions. The actual question is this: Medicare advantage programs -- and in particular the Universal Health Care Insurance Company's Any Any Any Plan which is in effect in South Carolina has certain fees and co-pays that Medicare does not. The Any, Any, Any plan would require the patient to pay 15% of the cost of surgery if it were done as an outpatient procedure at an outpatient surgery center; 20% if it is done in a hospital. The fact that Medicare requires an overnight stay in the hospital changes the procedure to inpatient status. The problem is that I cannot find any information about inpatient surgery. So the question is this -- if it is an inpatient procedure and the patient is registered as an inpatient, then is there any charge for the surgery except for the $300 per day co-pay. Your answer would be greatly appreciated. Thanks, sheila [email protected]

nope. copay would apply.