Dilated pouch. Will Medicare pay for repair?

Cluckernut
on 8/22/11 7:04 am - CA
I had a Roux-en-y last year and stopped losing weight after 2 months.  I just had upper endo and was informed that I had a dilated pouch.  I need repair.  Does anyone know what codes or info is needed to see if Medicare will pay for?
MsBatt
on 8/22/11 10:48 am
How much weight did you lose in those two months? What's your CURRENT BMI? I've been told that Medicare will cover revisions, IF your weight/co-morbidities still qualify you.

If you still have a high BMI, you really should consider being revised to the DS.
Cluckernut
on 8/22/11 11:15 am - CA
I only lost 30 lbs in about 3 months then the weight loss stopped.  I have remained at 190lbs since then Feb 2011 (7 months now). BMI is 35.  Co-morbities still High blood pressure, sleep apnea and tryglycerides went from 200 in Feb to 250 currently.  My Dr is going to call Medicare so I was trying to gather as much info as possible.
jemma28
on 8/26/11 11:55 pm - Houston, TX
I am afraid that they will not pay.  I have a blown out stoma and my BMI is back to 35 as well.  I went to MANY dr's seeking a revision and spent countless hours on the phone with medicare.  Since medicare will not pre-approve any surgeries, it is a crap shoot for the dr.  I saw at least 10 bariatric surgeons and the all said they would not do the surgery because no matter what/how/how many times the file with Medicare, the bill is denied.

Medicare does not have a cose and will not give you one even if you call and speak to a supervisor.

Sorry.  I was told if I wanted my MECHANICAL MALFUNCTION (not by my own fault) fixed, I would have to pay for the dr portion of it...the hospital will get paid, but the dr bill wont.  If I had $5000 to fix it I wouldnt be on medicare.
Jill


 
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