medicare

hi ! iwould like to hear from person who have medicare and their experince in getting approved bymedicare it would be a big help to me.thanks violet

I will be on medicare effective 2/1 and am waiting for that. All of the research I have done shows that medicare does not pre-approve. The surgeons know what the guidelines are and won't do the surgery if you aren't within those guidelines. As far as what you need to do to prepare for surgery, that is up to each different surgeon. The Wish Centers are now taking medicare, I don't know if there is one near you but if there is that would be worth looking into. The last thing is the cost. Medicare pays 80% if you have parts A/B. I have seen posts on other boareds that say medicare paid more than that, I am not 100% sure on this part. But I am sure there is an insurance person in the office that has experience working with medicare patients. Good Luck!! Kim

I have MediCare as a primary with Medicaid as the secondary. Medicare will pay for the surgery as long as you meet certain conditions. They tried to deny me first because my surgeon wanted pre-approval. Medicare will not pre-approve any medical procedure, but when your surgeon submits the bill for the surgery s/he also has to submit the medical reasons for you needing the surgery. I found this link online: http://www.cms.hhs.gov/manuals/06_cim/ci35.asp #35_26 specifically states weight loss surgery is not covered as a treatment for obesity. However it IS covered for treatment of other conditions made worse BY the obesity. Stupid I know... but there it is. If you get denied, refer the person who denied you to that web page (which is the official Medicare coverage site) and have your doctor document all your co-morbs for Medicare. They don't cover the whole cost though. I had to go out of state to get my surgery, and was financially responsible for the portion they didn't pay (Medicaid wouldn't cover it in another state). Good luck with your surgery plans! LadyT