I am a go to person with Insurance Problems

Becky I am not real comfortable giving you pointers on the DS and medicare.   I know you would have to pay the inpatient medicare part A deductible and the part b deductible and 20% of the surgeons, anthesiologist and any other people who basically touch or see you in the hospital like a radiologist pathologist etc.    As far as the seminars required that is another thing I would not be able to assist.  I do know our Bariatric center takes Medicare patients and they do pay for RNY and Lapband but not sure on the DS.

I think if you would contact Diana Cox on the DS board she might have more insight on the DS with Medicare paying or not paying. 

Becky-

I might be able to help point you in the right direction, I work as an admin assistant in the MA/Supp Industry. **Disclaimer: I am NOT a licensed insurance agent, please do not make any major decisions without consulting the state DOI or a local, licensed agent** (Sorry, gotta cover my butt... LOL)

Here is what I would recommend: 

Look into "Medigap" plans. They are basically supplement plans that pick up the remaining 20% that regular Medicare does not. Some plans require underwriting..... some do not (it varies carrier-to-carrier and state-to-state).... so you might be able to find something that'll work for you.

Rather than being stuck with the massive 20% co-pays..... you'll (generally) only have the monthly premium to pay.... which is probably going to be a MUCH better deal.

Go to the official Medicare Website:

www.medicare.gov/MPPF/Include/DataSection/Questions/ListPlan ByState.asp

Scroll down.... on the bottom left, there'll be a box that says "Learn More About Health Plans and Medigap Policies in Your Area"

Select your state and click on "View Plans"

The next page will load and it'll have you select your county, etc..... underneath that, it'll say "You Are Currently Viewing"..... make sure "Medigap Policies" is selected... and hit "Update Results."

It'll pop up all the available types of Medigap plans in your area.

I will warn you that it's quite confusing.... so I would highly recomend you get in touch with the state DOI.... or a local state-licensed insurance agent. They can give you more area-specific, detailed information about the types of plans, how to apply, etc. Plus, if you find a good agent, they'll follow up with you from time to time and let you know if anything comes along that might be better-suited to your needs.

Good luck, I hope that helps.

Hey there Vicki! I'm glad there is someone out there that might be able to answer a couple of questions for me.
I have Midlands choice and I was just wondering if you've heard anything about them denying coverage for WLS. I read that they do not cover any treatment for obesity but didn't read too deep into that. Even if an insurance company says they don't cover that you can send them a letter of medical necessity right?
So I'm just kinda looking around on here to see if I even have a chance a getting the surgery  paid by them.
Well thanks in Advance!!

Vicki Help Me!!!

Hello! My name is Ilene, and I can’t say how happy I am about the last post I just read from you stating that you were there to help with insurance questions! I’m stumped! I have tricare prime. I don’t know if I need a referral from my primary doctor, or if I just go. I know tricare covers the Lap Band surgery (that’s what I’m looking into) but I also heard it was super hard to get them to cover it. What’s my next step? Im 5' 5" and  275LBS. I have suffered with obisety my entire life! Help me please! =]

Thank you so so so much for your time!

Hello Vicki I am totally new to the site but not my quest for WLS, I work from home I have no insurance nor do I have any money saved for a percent pay, I am trying to find an insurance company in Florida (Escambia County)  that will cover WLS.  I am lost, a little discouraged but not defeated in my search to get to a healthier, happier me... anyhow I will bother you and get on your nerves because I don't know a thing about getting this process started so please be patient with me ! Thanks

Hi Vicki, I have a question about insurance.

I am in the process of looking into getting private insurance. I know that Anthem will definitely cover the lapband procedure. However, when looking at their application process it says that there are height and weight restrictions. So I'm a little concerned that I won't get approved for private insurance with my h&w . Do you know anything about companies rejecting people because of their weight? Thank you for any help you can give me.