MEDICARE-How many months required for medically supervised diet?

Hi everyone! I have been AWOL the last few weeks. I have been very busy fighting with my insurance company Independance Blue Cross Blue Shield to get a revision from a vertical banded gastroplasty to a duodenal switch. I was denied initally right off the bat. I filed an appeal and that was denied. It looks like the insurance policy is iron clad when it comes to revisions for any reason as an exclusion. 
So...I am going to try with medicare part A and Part B. I have everything in place except a medically supervised diet. Does anyone know how many months MEDICARE requires of a medically supervised diet? Any info would be appreciated. Thanks.
*I would like to take this time to all who helped with with kinds words, encouragement and information during the process. It has been very hard on me.

*Also posting on DS and insurance boards. Really need an answer on this one.

I believe the answer to that is ZERO months - I don't think medicare requires any pre-op diet!

For real? That would be awesome. I hope so. I will post on the board as soon as I get a verifiable answer. Thanks!

Dear Mary,

My name is Sondra & I am 44. I am new to this site and to searching for information on weight loss. I have MediCare A. I am newly diagnosed as "disabled" & Looking for support group. Im thinkin that a lot of my health issues go back to my increasing weight gain.I know there are steps involved in asking for a medical procedure, such as medically supervised diets. Can you recommend how I would approach this whole topic with my doctor? I noticed that the Medifast diet is over 300.00 a month. I have 2 kids and am now single on limited income (SSI/SDI). I wonder if you have knowedge/experience in this area? Frankly, I cannot afford a surgery either. I was reasearching "Medicare covered diets" and came across THIS site.

Any help on topic would be greatly appreciated.

Thanks,
~~Sondra
[email protected]

I answered below to the other question (from the original poster), but to answer your question, I think just tell your doctor you can't afford to do a diet that requires buying specific name-brand diet products (such as Medifast).  As far as I know, insurances will not cover any such products to help a person lose weight.

I had my DS 16 months ago with Medicare paying.  There was/is no supervised diet required, only that it be done at a center of excellence. Good luck! 

Both DS surgeons here say that Medicare requires a 6 month medically supervised diet. Joyce

The 2006 decision memo http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewde cisionmemo.asp&id=160& makes no mention of a supervised diet.  When this question came up last year I sent an email to the contact person listed on the decision memo.  What follows is the answer I received.  Which was not very specific or useful.  I would be happy to send you the name and email address of the woman to whom I sent the question so that perhaps you could get a better answer. Red _______________________________________________________________________

We have made no changes to the national policy on bariatric surgery.  However, some of the local Medicare contractors have local coverage determinations that outline in more detail some of the requirements. The national coverage determination uses broad language when addressing the weight loss provision of the policy.  This leaves the more detailed requirements to contractor discretion. I hope this helps to clear up any confusion.

 

 

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Sent: Sunday, March 18, 2007 9:41 PM Subject: Bariatric surgery

 

 

Have the Medicare requirements for bariatric surgery been changed to include a mandatory supervised diet (six months or 12 months)   There is a persistent rumor that this is the case, however, I cannot find documentation of any changes since the Decision Memo was published in Feb 2006. 

 

I have Medicare and was not required to go on any physician-supervised diet.  Now I am on my way to the Wizard!

Hello, I also am going to have DS with Humana Medicare, I was told by Medicare if there are comorbidities which is, Diabetes, Sleep Apnea, High Blood Pressure, that medicare does not require supervised diet, Hope this helps. Sandy