medicare in Tn

 v hi, i'm fairly new on oh and i was wondering if anyone in tn or i guess anywhere has applied for wls and have medicare, did you have to jump through any hoops???   So far some people have told me it was easy getting approval, now i have read about a 6 month diet requirement ,,,,,,any one  know ?????? Thanks for any replies,,, sherry  i have bmi of 40, diabetic, osteoarthritis, and 1 diet program from a doctor

Hi and Welcome, I have a medicare policy thru Human and it runs pretty much by what Medicare requires.  I did have to do the 6 month medical supervised diet.           Altho i have read. that medicare now no longer requires it. I would definately contact medicare and get the info straight from the horses mouth.  I tried to find the link that stated it.. I will look a bit more and see if i can find their requirements online. Mine was.. BMI 35-40 w/ one co morbidity 40-above no comorbidity Psych Eval Nutritionist Eval. Surgeon and Surgery to be done in a "Center of EXcellence"  (very important) 6 month medically supervised diet. I will keep looking on line at the medicare webpage and see if i can get more info for you. I will post the links............. From what i understand it is fairly easy to get approved......  but i guess everyone is different. Take Care  Michele

Thanks for the in-put,,,i have appt set up at vanderbilt for seminar and appt to see their nurse practioner this month. I have already went to pcp and got a letter of approval,  but i'm going to go ahead and call medicare and assk their requirments,,,,,it seams like these insurance requirments change like the wind...how long did it take you from the time of the seminar to surgery???  take care thsanks again for replying,,,sherry

Hey... I am from Humboldt, TN. I am struggling to get some information about Medicare. I have Medicare A and B and TLC Tn Care........I have had every required test  I have the diet history attempts in my file and clearance letters for GBS from all my doctors......... I was told April 20th that Medicare is now requiring 18 months of 3 different attempts lasting at least 6 months each!!!!!!!!!  I got the Medicare TN link and I read it as  attempts (usually 3) diet, exercise OR drugs..key word OR . My surgeon's staff are interpreting the Feb 2007 rule is a total of 18 months of diet, exercise and drugs. The Case manager told me that the surgeon hasn't been paid for surgeries he performed last NOVEMBER!!!!!!!     They are trying to sift through all the paperwork and red tape to find out what is going on......in the meantime I am stuck!! My BMI is 41, I have severe sleep apnea, COPD, Depression, Type 2 diabetes,HBP, an enlarged heart,allergies. Medicare told me that I have met all the requirements so I am trying to not stress out over this and I am putting all my faith into getting this moving again......But I ain't  kidding it is very hard. Has anybody else had this kind of problem? Does anybody have Medicare? Did anyone go through all this  mess? Tisha

hi, i dont know how much help i can be , but i just went to vanderbilt in nashville seminar and went for 1st appt with their pcp, he cleared me to have the surgery but i have to go through the 6 month diet , i  have been on plenty of dc's diets but they really didnt follow through enough.  I'm going t o use my 6 months wisely.....I am going to get my psych val done and go ahead  and start my nutrician classes and attend some support groups. I started out this tripppp at another hospital in Nashville and they were also having trouble with medicare paying,,,,,,so i switched to Vanderbilt and i'm pretty pleased with their service.... One more thing---- you can call medicare yourself, i did. They are pretty good , just write down what they tell you, who you talked to and the date and time,,,,,,good luck , dont give up , sherry

 Hey Sherry,        I have done every thing Medicare has asked. I called the medicare  bumber on the card..and had to wait 30 minutes then got transfered and had to wait 25 minutes and the line went dead...called back started the process over 30 minute wait....then  another wait then an Agent who tried to conect me to some else and guess what the line died...........So I patiently called back......waited again...................then FINALLY an agent came on and said he would transfer me to someone else...then I got transfered to an Obudsman?? They said no we are only here to support claims against the doctor...so they transfered me AGAIN!! Then the message said 45 minute wait.....................I got another agent who told me that according to what she had in front of her I had met ALL the requirements!!!!!!!! I said can you call my doctor and explain to them  that is 6 months of a single attempt of either diet,exercise  OR drugs.........and three different attempts...........My doctor is interpreting it as 18 months in a row!!!!!!!!! The agent said they can't call out.             GRRRRRRR. You will not believe how much faith I have.......I KNOW I will get to have my surgery...I have no doubts.....I just wanted to have it while my daughter is out of school for the summer...........I guess it doesn't have to be when I want it...but when HE wants it............( the man upstairs)...........I forget HE has control...............Any suggestions...........????????? Tisha

hey,,,i guess i got lucky with medicare, i got an automated message when i called in and the wait was so long i got to schedule a call back------they did call back on the right day but not the right time,,,,,lucky for me i was home.. i wrote down the day, time and who i spoke with.......... I get really annoyed and frustrated too, it seams they just drag this thing out ...From what i've read on here we are not alone it seams most everybody goes through this. All we can do is keep on keeping on and remember the old saying good things come to those who wait,,,,,,,sherryhang in there