Tencare

Does medicare and/or tencare pay for WLS??? Just wondering.... Thanks Tina

Medicare does I hear. TennCare does until the end of this year, then it's excluded.

william, when did you hear that they were excluding it ??? I am waiting to hear from my disability and wouldn't you know it... it won't happen until NEXT YEAR!! It is never going to happen for me.... I feel so depressed now..... thanks for answering my question ya'll.. Tina

Medicare doesn't give prior approval. But they do have certain things that must be followed. I have it and tncare. Medicare won't pay for it unless you have a medical problem prior to obesity that caused obesity. I have a thyroid disease that causes me to gain weight, I also have to be on two different antidepressants that also cause weight gain. Right now, TnCare is paying for the surgery but must have prior authorization, with me being on Medicare, TnCare picks up what Medicare doesn't pay. Hope that helps you understand them better. Medicare also now says that if the BMI is lower then 40 you must do a 6 month diet program, if over 40 you don't need to. I don't need too, sitting in a wheelchair caused mine to go up. Best of luck on your journey and May God be with you. Kathy

Hey sweetie, My BMI is WAY over 40. matter of fact it is 73.1 according to the bmi calculator. But it doesn't matter.. my insurance won't pay, soon tenncare won't pay and medicare will be a hassle then too... I just feel so..... well not to worry... You have been through so much... and you still keep a smile on your face...I know you can relate to how I feel... Love you all SO MUCH!!! Tina

Tina... My name is Karen and I live just north of Cookeville, in Gainesboro. I had surgery June of last year...I am insured with TennCare and everything was paid for, even my TT, which I had done in June of this year. Call TennCare and find out who they have on their list of Doctors. Or if they say they don't have any check with some of the other people here. I am sure they can send you to a good doctor. I would send you to mine, but she is no longer in the state Also, there is a support meeting at the hospital the second Wed of every month at 5:30 in the meeting room across from the nursey. Why don't you come next month and talk to us...Everyone there is very nice and you can get alot of information. If you need to talk about anything my regular email address is naillady54 at hotmail. Look to hear from you soon. Karen Your new friend in WLS 6-30-05 RNY288/119 staying here with the help of the good guy above.

Karen, Thanks so much for the info... but if what william said is correct I won't even have to worry about it... Keep in touch though... my email address is myreply1 at gmail.com, I would love to keep in touch. Tina

I recently testified at a hearing on the changes in Tenncare. They were still accepting input on whether or not to take bariatrics out of the coverge. This weekend I found the document below, revised Sept 2005. Page 36 seems to indicate that they have put it back in the coverage. I don't know if this is final or not so we will have to keep monitoring the situation but at least there is HOPE! Jama http://tennessee.gov/sos/rules/1200/1200-13/1200-13-13.pdf

LOL!!! Ok, I am confused.(whats new) I have TennCare/mediCADE. Is there a difference??? I really need to know, because I won't be having my surgery till '06 also. Thank's, Sara.

Not so much as a difference, my TnCare Blue care pays for 5 out of 17 medications, Tn Medicade pays what Medicare doesn't pay for, like hospital and Dr. appointments. Anything else you need to know feel free to email me. Always, Kathy