MEDICAID AND MEDICARE SURGEONS LIST!
Actions speak louder than words...
Name: Dr. Younan Nowzaradan, M.D.,F.A.C.S.
If they accept Medicare and or Medcaid: Medicare for sure not real sure about Medcaid (call office, the girls are wonderful about helping.)
Phone number: (713) 661-6262 or 1-800-607-6262
Facility: He does his surger out of many different hospitals.
Address: 4009 Bellaire Blvd. # K Houston, TX 77025
This is the bitter, ugly truth about Medicare/Trailblazer in Texas and I guess the rest of the country.
I think it is VERY important for people with Medicare to understand that if they do not meet and complete ALL of the criteria set forth by Medicare they will be stuck with a huge hospital/surgeon bill because Medicare will not pay! PERIOD!
Some key points in the Medicare/Trailblazer guidelines are:
Patient must suffer from some weight related medical problem that cannot be adequately be controlled without surgery that can include:
v Body mass index greater than or equal to 35.
v Type II diabetes mellitus (by American Diabetes Association diagnostic criteria)
v Refractory hypertension (defined as blood pressure of 140mmHg systolic and /or 90MMhG diastolic despite medical treatment with maximal doses of three antihypertensive medications).
v Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).
v Obesity induced cardiomyopathy.
v Clinically significant obstructive sleep apnea.
v Obesity related hypoventilation
v Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for the obesity).
v Hepatic steatosis without evidence of active inflammation.
Patient must have participated in a physician-supervised diet and exercise program for at least 6 consecutive months during the 2 years leading up to surgery, and must have been in one program for at least 3 months in a row during that time. The diet/nutrition and exercise program must be supervised and monitored by a physician working in cooperation with appropriately trained dietitians and/or nutritionists. Participation in the nutrition and exercise program may NOT be supervised by the surgeon who will perform the surgery. NOTE: A physician’s summary letter is not sufficient. Documentation should include medical records of the physician’s contemporaneous assessment of the patient’s progress throughout the course of the nutrition and exercise program and must include, at a minimum, summary statements of the patient’s course prepared by the nutritionist, dietitian and exercise program director. A sample copy of an appropriate preoperative diet record to be completed by a physician each month is included. You will want to take the sample copy to your Primary Care Physician and arrange to see them a total of 7 times (One initial diet visit and 6 follow up visits – each visit between 30 and 32 days apart; no more and no less). They will need to complete the included form for each diet and nutrition visit.
Patient must have an objective examination by a psychiatrist or psychologist experienced in the evaluation and management of bariatric surgery candidates to exclude patients who are unable to personally provide informed consent and who are unable to comply with a reasonable pre- and postoperative regimen.
Patient undergoing bariatric surgical procedures should undergo preoperative evaluation that is medially reasonable and necessary based upon his comorbid medical conditions and medical/surgical history. All underlying medical conditions that will likely impact or complicate the patient’s surgical and postoperative course must be adequately controlled before surgery.
If a patient goes through surgery without all the proper documentation being in place, then Medicare will not pay the surgeon, anesthesiologist, hospital or anyone for the surgery. This policy has been in effect with Medicare / Trailblazer (the entity that administers Medicare for Texas and several other states) since May 17, 2007.
If you would like to contact your lawmakers:
John Cornyn (R – TX) Kay Bailey Hutchison (R – TX)
517 Hart Senate Office Building 284 Russell Senate Office Building
Washington, DC 20510 Washington, DC 20510
The Medicare situation is disgraceful and it would appear that they are deliberately trying to keep people from having access to care.
Everyone on Medicare should stand up for their rights! Medicare wants you to jump through hoops and they want you to believe it's the physician's fault. IT'S NOT! They set unrealistic criteria and then won't provide benefits for the patient to get the care to meet the criteria.
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I assumed the criteria for WLS under S.S. were est. by FEDERAL S.S. regs, and not left up to the individual state contractors .. I see plenty of opportunity there for abuse of insureds by the S.S. carriers, as before with private insurors ..
No wonder one sees so many people on S.S. disability that badly and desperately need WLS but haven't gotten it, at least here in Texas .. 
Does the Obesity Action Coalition know about this situation? I wonder if they are doing anything on this front ..
Frank talk about the DS / "All I ever wanted to be was thin, like that Rolling Stones dude ... "
HW/461 LW/251 GW/189 CW/274 (yep, a DS semi-failure - it happens :-( )
My insurance doesn't require the diet thing, so it is the insurance. (I'm on a Medicare replacement)
None of the stuff my insurance requires is stupid and abusive.
Because I was a nurse for 30+ years
, I tried to talk them out of the 6 nutrition classes I had to have, but, they wouldn't give. So, I shut-up and figured I might larn sumpin, and do what I need to do.
The only good cat is a sleeping cat...>^--^< zzzzzzz
