New Here And on Medicare. Any tips on getting approved?

Im pre-op and still on the weight loss program. My HW was 438. CW is 416. A loss of 22 lbs. in my 1st month. Half of what I need to lose for surgery. My 1st appt. with surgeon is Friday, May 17th. Im wondering if anyone else is or was on medicare and what to expect from them. I believe I have 6 months of weight loss and all the other stuff before I can have surgery. Ive been reading alot of posts on here and most have been very inspiring. Im anxious to have this done. Ive been overweight all my life so far and have a whole new life to live after this is all done. Thanks for any advice.

With Medicare I always thought it was much easier than Medicaid. I may be wrong but I didn't think there was a diet required with Medicare.

I used Molina which is basically Medicaid. I had to complete a six month diet. Once I completed that and the other requirements like a sleep study, pulmonary and cardiac clearance, I was approved the same day it was submitted to insurance.

Medicare does not pre-approve WLS.  If you meet their criteria, you have surgery, the hospital and surgeon bill them, they pay their 80%.  Super easy.

They did not require a six month diet when I had my surgery four years ago.  I don't think they do now, either.

This is if you have Medicare Parts A and B.  If you have a Medicare Advantage Plan, the process will vary depending on your plan.  Contact them to find out what their requirements are.

Thanks so much for replying. My PC doctor and the nurse I spoke to from the surgeons office told me I need 6 months. Hmmm. I have to lose 10% of my body weight. Guess Ill have to see what the surgeon says when I see him on friday. I was hoping to get this pushed thru sooner than 6 months. Maybe Ill get lucky.

I just had surgery January 24th thru Medicare. There was no pre approval. You just have to meet their requirements for surgery. A certain bmi, specific comorbidities, 5 years of recorded weight from a doctor and I forget what. Call them and they will tell you. My BMI was 54, I had a little high blood pressure and was on meds for this and could provide the needed weight record. There was no required pre op weight loss and no required participation in a weight management program. Medicare paid 80% and my AARP supplemental plan F picked up the other 20% so I was not out one penny. Even had a private room.

Thanks for your input. I can only hope that the surgeon and medicare work together and get this thru for me. I know that I meet all the requirements. But I dont have recorded weight records  unless I go to 5 different docs to get my weight every time they took it. Glad everything went good for you. And a private room, wow!! Hope your doing well.

I just got approved through medicaid and got my June 3rd surgery date. I used my 4 year old sleep study, had a counselor write my psych evaluation, got clearance from my cardiologist, had a full workup with pulmonary, did my nutrition class, and did one full year of supervised diet, although only six months was required. My advice is to make sure you go in for your diet appts on the same day each month, no exceptions, weekends beside. My Dr sent three in and only two of us got approved because of the diet part. I didn't have to lose any weight which is good because I actually gained eight pounds. I paid $150 for my nut class and $150 for the surgery. Hope that helps.

I am on medicare and had my surgery on April 2, at your weight your bmi is high enough then they will approve you..there is no waiting time of 6 months or anything like that.  I have humana as my supplement, medicare paid their 80% and humana paid their 20%...oh I did have my 35$ co pay for the office visits. The will however only approve for certain doctors so you should call your supplement if you have one and talk to them about which centers they cover in your area.  good luck!!! It will be the best thing you have ever done for yourself!

Thanks so  much for the info. Im in my 2nd month of pre-op diet. Not sure why I have to do this according to what everyone said. But surgeons office and family doc said I do. Ive totally cut all the foods Im used to and really watching what Im eating. I keep my appts. and I am losing weight (which never hurts). The drive to the surgeon is a 3-4 hr drive. But Im determined to do this. I do have a state funded supplement. Ill have to wait till friday and see what the surgeon recommends. Thanks again.

I would definetly call medicare and talk to them about it...as well as the state insurance