Medicare?
Here is a link for what medicare approves
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5013.p df
If approved you would be responsible to the part a deductible for the inpatient stay and your doctors , anesthesiologist and surgeon after med b dedictble then you would be required to pay the 20%
on 7/9/09 8:23 am - KY
Medicare covers the following:
- BPD/DS aka DS (Biliopancreatic Diversion with Duodenal Switch) (lap and open)
- RNY (Roux-en-Y Gastric Bypass) (lap and open)
- AGB aka Lap-Band (Adjustable Gastric Banding) (lap only)
Each procedure must be performed in Medicare-approved facilities. For a listing of them, click on this link:
http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.as p#TopOfPage
Medicare does not cover the following:
- VSG (Vertical Sleeve Gastrectomy) (lap and open)
- VBG (Vertical Gastric Banding)
- AGB aka Lap-Band (Adjustable Gastric Banding) (open only)
- Gastric Balloon
- Intestinal Bypass
As for revisions, Medicare covers open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB) and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) if certain criteria are met and the procedure is performed in an approved facility.
Source: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=100.1&ncd_vers ion=2&basket=ncd%3A100%2E1%3A2%3ABariatric+Surgery+for+Treat ment+of+Morbid+Obesity
Medicare does not pre-authorize any medical services that are considered "medically necessary". For WLS, "medical necessity" is defined as follows:
BMI of 40 WITHOUT any co-morbidities
BMI of 35 WITH at least one serious co-morbidity (such as hypertension [high blood pressure], heart disease, diabetes [Type 2], and sleep apnea)
Hope this helps!
Vicki
DS (lap) with Dr. Clifford Deveney. Cholecystectomy (lap) with Dr. Clifford Deveney 19 months post-op.
Has not weighed myself since 1/2010. Letting my clothes gauge my progress instead.
Thanks so much. I had learned the first part (which procedures that Medicare covers) but I had not yet learned that they don't pre-authorize "medically necessary" or what "medically necessary" means in this situation.
So with my BMI at 39.5 and hypertension I should be good to go?
Then I will just have to follow the surgeon's protocol in terms of jumping through hoops?
That sounds GOOD to me!!!
I am attempting to jump thru my surgeon's first hoop on Tuesday: making sure my pcp will agree (in writing) to provide all non-surgical follow up care. I bet she is going to take every advantage of this new found power over me and make me have very damned test there is to take. Dear God. It will be awful.
Becky in NC
Yep!
"Then I will just have to follow the surgeon's protocol in terms of jumping through hoops?"
And Medicare's too! Each surgeon has his/her own requirements and their mileage may vary.
Best of luck!
Vicki
DS (lap) with Dr. Clifford Deveney. Cholecystectomy (lap) with Dr. Clifford Deveney 19 months post-op.
Has not weighed myself since 1/2010. Letting my clothes gauge my progress instead.