Medicare and Revisions

Does anyone have any experience with Medicare and revisions?  I had vertical banding in 1998 when I was working and had insurance that paid for it.  Now years later I have slowly started to gain all my weight back(I still have not gained all my weight back).  I am now unable to work and am on disability with Medicare as my insurance(I am 42).  I seen provider in St Augustine that does revisions and takes Medicare.  I have now met all criteria for Medicare and all that is left is for me to have the nutrition class and the actual surgery.  I am wanting gastric bypass.  Was told Friday, that as of Thursday, facility is no longer taking Medicare primary for revisions as for some reason they are not being reimbursed.  The doctor's office doesn't know why the hospital has decided this or why Medicare is not reimbursing for the surgery.  I called Medicare and they verified that it is a covered benefit and I do meet all the criteria, and they don't understand why the hospital is not being reimbursed.

Does anybody out there have any experience with Medicare and revisions, that can offer some help.  The person at Medicare suggested that I find another Medicare provider and switch.  The doctors office office manager is supposed to be talking with the hospital to see if they can get it reversed.  I've gotten 3 names of physicians that according to this web site does revisions, and according to Medicare accept Medicare, but I was really wondering if someone has experience with this and could offer me suggestions.

Thanks in advance.

I can't help you with your basic question, but I can tell you that you really owe it to yourself to consider the DS rather than the gastri bypass/RNY. It's been shown to give better results, especially for those of us with a starting BMI greater than 50, and it has the highest maintained excess weight loss long-term for any starting BMI. Medicare covers the DS, and the DS post-op lifestyle just can't be beat. (*grin*)

I just had a revision from RnY to DS two weeks ago and Medicare (Secure Horizons) covered it minus some co-pays. In most states, to my knowledge, medicare is in the forefront of covering original WLS and revisiions. Have no idea bout your particular issue.

Thanks to both of you for your replies.  I still don't know what made the hospital in St Augustine, Fl, change it's mind about accepting Medicare for revisions, but I have found another provider.

When I was able to work, I was a RN and when I worked at Tricare(insurance for the military) I sent alot of people to Dr Nye in Pensacola and heard good reports about him.  The only reason why I didn't check into him in the first place is because of the distance factor(it's only 2 hrs away to St Augustine, but it's 4 1/2 hours away to Pensacola).  I have an appointment with Dr Nye on the 15th to see if he will agree to do the surgery on me.  Wish me luck.

I have researched the DS procedure and while it does seem to have less "side-effects" than the rny, I am seeking the rny, as I am a sweet eater and if I know I will get sick from eating sweets I won't eat them.  What I read on the DS is that you can pretty much still eat sweets(or you have a better chance at it than the rny), so that is why I am seeking the rny.  That and 2 of my aunts have had the rny with great results.  I have already started cutting back on the sweets to try to get ready for the surgery, I've done so good that they have decreased my meds from 2 pills to just 1/2 pill, but I still eat them, just not as much, but I do realize that after surgery I won't be able to eat them.

Thanks again to both of you for your replies.

Dorothy