Anyone with Medicare in South Dakota who got surgery approved???

Hi, I will have Medicare coverage in April, but I'm trying to do some research on how to get the surgery covered. I know that I will need to go to a Bariatric Surgery Center of Excellence. However, I was wondering if anyone was familiar with the Medicare Health Plans you can buy into instead of just the Original Medicare. Which one would cover surgery??? Any information about your own experience would be appreciated. Thanks! Desiree

I'm in South Dakota and have Medicare (Although this applies nationwide). Medicare will pay for WLS. They have 3 requirements: BMI greater than or equal to 35, Failure of medical obesity management over the past 5 years (Documentation of a medically supervised program required), and the presence of a co-morbidity. You do not need an additional medicare plan to cover the surgery. It's paid for by traditional medicare. Medicare DOES NOT pre-approve (or deny) WLS's. Therefore, the decision is made by the surgeon's office as to whether you are qualified. I am currently in the process of documenting my medically supervised weight loss. DO NOT LOSE HOPE if you don't have this. I am working on what will probably only be 1-2 months of documented diet efforts. Because medicare does not specifically require a lengthy diet program (as most private payers do up to 6-12 months), the surgeon's office can make a decision based on the totality of your health information (obesity, co-morbids, and failed diet) and approve you pretty rapidly with the confidence that they are going to get paid by medicare. Sioux Falls has two centers of excellence: Sioux Valley, and Dakota Surgical Ltd. at Avera McKennon. My surgeon (and the people who have helped me understand how to qualify) are the folks at Dakota Surgical Ltd. Dr Harris and his staff are incredible!!! I hope this gives you hope. Yes, medicare does pay! And its hurdles are lower than most private insurers! I can not more strongly recommend Dr. Harris @ Dakota Surgical Ltd. The man has been doing the surgery for decades, has a 0% mortality rate (WOW!), and his staff is amazing. (Am I repeating myself?) Including my 1-2 months of diet for medicare's satisfaction, my whole process from referral to surgery day looks like it's going to be 3 months. That is incredible! Go with Dr. Harris! Go with Dr. Harris! Go with Dr. Harris! -- Jonathan

Thanks for all the info. I really appreciate your time responding here and sending me the personal message. It gives me more hope. Anyhow, I'm going after this with everything I've got. I have already begun the "diet" phase as I'm working with our IHS Clinic's dietician. She has yet to come up with a plan for me, but I've already been cutting back on portions and empty calorie crap. Well thanks again and best wishes in your process. Oh yes, and I plan on going with Harris. I'm looking forward to his Feb.6th seminar....I hope he is as nice as everyone says.

You're more that welcome, Desiree. Working with the IHS dietician is going to be perfect documentation! I should say that in my post I wasn't clear that they need evidence of a failed attempt, but not 5 years of failing. They just want 5 years of records, and somewhere in there it needs to show your documented attempt. FULL SPEED AHEAD! BTW, remember that Dr. Harris is a SURGEON. Do not expect him to have the same bedside manner as your family physician. He is kind, but very to-the-point and terse. You'll like him all the same. :) -- JP