I have a question....

I am looking into weight loss surgery and i am on medicare and medicaid and was wondering if they covered it. (i am disabled)  I know that medicare will cover 80 % i think but will virginia medicaid pick up the rest.

Hi and welcome to the Va board.

Yes medicaid will pay for the surgery. I have a good friend that had it done through medicaid. I don't know if they will cover Lapband or the DS but I know they cover RNY.

Good Luck!!

Medicaid will probably pay.  I tried to have it done years ago when I was on Medicaid and was denied.  I do know several folks that are on Medicaid now and have had it done.  It all depends on your type of coverage and comorbidities.  Good luck!

Are you sure Medicare only covers 80%? I have heard good things about Medicare's WLS coverage (including that they also cover the DS), but I know they require that your surgery be done at a Center of Excellence.

I had my surgery done in March and had Medicare and Medicaid and was covered by both and didn't have to pay a dime. They bill Medicare first as your primary and then Medicaid second as your secondary. Once Medicare approves you, Medicaid automaticlly approves you so there is no problem with billing. It was great. Of course, being on so much medication for comorbiditiies, they are happy to find something to reduce that cost. I am now off of high blood pressure, colesterol, and diabetes medications. My surgery will have paid for itself in 2 years. However, I was told that Virginia Medicaid does not pay for Lapband surgery, still considered experimental and too many patients were coming back to get revisions to RNY. Pam 

When I had my surgery, April 30, 2008, the only thing Medicare covered was the RNY. Now that may have changed and it may depend on which Medicare, if it is an HMO thru Medicare. I myself had straight Medicare and straight Medicaid.

But you are right about it having to be done at a center of excellence.

I will say upfront I am NOT and Medicare expert by any stretch of the imagination! But this is where I have been directed regarding their coverage of the DS (and the band), not just RNY:
http://www.cms.hhs.gov/Transmittals/Downloads/R54NCD.pdf

According to CMS (the Centers for Medicare & Medicaid Services), Medicare coverage of the DS began in 2006.

Hi! I am on disability due to congestive heart failure and I have Medicare & Medicaid as my secondary insurance. I had laproscopic RNY 9 months ago & it and all that led up to it was completely covered. There are things you have to due, such as certain appointments and there are requirements that you must meet, such as certain comorbidities and you MUST go through a center of excellence, like St Mary's, in Richmond.

The down fall to Medicare paying for it is that they DO NOT do pre authorizations. Meaning that the surgeons office will not submit your paperwork before your surgery to see if it is covered or that they will pay. You are required to sign an ABN, advanced beneficiary notice stating that you know they have not agreed to pay and should they deny payment, you are responsible. Only after surgery will Medicare be billed and the decision will then be made.

I'm not sure about the 80%. That may be dependant on which Medicare & Medicaid product you have, such as the HMO's in each division. I myself, have straight Medicare and Medicaid and Medicare paid for all of mine except 4 $1 copayments I had for my pre op appointments.

If you have any questions or just want to talk, feel free to message me. I can recommend a good surgeon, MINE, lol but not sure how far away it would be for you. Good luck.

Mine was done @ UVA and was covered in 05 so you might have to check around and w/ surgeons to see who excepts but I dont think there will be any problems. Good luck!!