So I Called Medicare

Hello all. I know I haven't posted on the board in a while but I have been trying to get some things straightened out and starting my diet. Now about the diet. I have recently read that some people on Medicare were required to be on a 6 month diet before surgery and some weren't I am on Medicare, just plain Medicare. I have called them twice and both times I got the same answer. They are telling me that they are not requiring a 6 month diet for bariatric surgery. Both representatives read the same things to me, and nothing was changed in what they read. Today when I called I thought that perhaps my state of residence may have had some bearing on it so I told them that I lived in the state of TN and nothing changed about their requirements. In the meantime I am being told by Vanderbilt that I have to be on a 6 month diet as required by Medicare. Hmmm! go figure. All I can say is that I am one more angry and confused woman right now.

I guess you are and I am sorry I dont want to confuse you anymore but medicare is my 2nd and I didnt not have to be on a diet for 6 m but my prime doc had to show where i have been trying for some time plus i have a lot of health issues. i was told medicare likes to have phyc evals so i did it right away and had doc turn everything in. did your prim doc write letter to medicare about the surgery? Annrenee

Hello Annrenee, I have been on diets in the past and my doctor was all for me trying to lose weight also I have a BMI of 62 not to mention high BP, osteoarthritis, onset of NASH, asthma and acid reflux. I don't know about this WLS thing. It's very interesting so far....LOL and yes my doctor has already written her letter. I do hope things get easier and better for me. Thank you for your reply. Carla Diane

This may not help couse im new to this site, but not to looking into the lapband. I been looking in to it for some time now, over a year, and just now decided to just do it. Anyhoo, i to live in TN with medicare and am being told the same thing bye Dr Colquitt's office that Medicare require's a 6 month dr monitored diet. I have tried to call medicare and all i got from them is they can not pre-authorize anything. I went to the seminar last night and learned nothing i already did not know ECCEPT i have to have $500 at the start and that the fills or not covered bye medicare ($300).

I was told the same thing by medicare but I think it is up to the doctor. I think we should just continue along the path and get everything started my problem is I cannot find a internal medicine doctor (family) to accept me. I will though. I hope you have a great day! DONT GIVE UP! ps medicare IS my primary

Hi I had medicare for my surgery. They won't give you prior approval. I never received a bill for anything. Medicare will pay if your BMI is over 40 with several co-morbilities, but Dr. Colquitt or whoever you have may be asking for the 6 month Dr. supervised diet. It goes towards your total weight loss. It also makes it easier to recover with that extra weight gone. If your BMI is that high, more then likely you have a fatty liver and that needs to be shrunk before surgery. That could be why you have to do a six month diet. My BMI was 53 with several co-morbilities and I have Chronic Myelogenous Leukemia. I am now 127.5 bmi is 22, and I'm 15 months out. I have a problem getting in my protein, water, and I am unable to excersise because of the dizzy spells and passing out. I wish you the best. May God travel with you on your new journey, Kathy

Hello Kathy, I do have a fatty liver. I found that out this year during my annual physical. I am already on my diet. I don't have a problem with the diet but I just don't want to be lead in a different direction if it's alright to go in the direction I was going. I'm also thinking about the fall I'm supposed to be returning to school and that will surely be interrupted because my diet will end then and all required testing will have been done. I've already lost several pounds. As a matter of fact I had already lost some weight the day I was weighed for my consultation. I'm doing fairly well but now I have "the medical community" preaching to me about making sure I get enough calories because my body tends to lose weight rather fast when dieting, problem is I can't keep it off. I go for my weigh in on the 23. I'll be on pins and needles. Looks like I need to add a ticker to my profile now. I chose Dr. Torquati at Vandy, if I'm still there. I have ran into some rather rude people. I think things will go good for me. I'm such a determined woman that I think it kills a lot of people. Oh well their problem not mine. Thank you for your response!

Both representatives read the same things to me, and nothing was changed in what they read Diane, This statement, I assume, means they have a procedure in place. Ask them to send you a copy of the document that they are reading to you from. If you have the document in hand, you and your PCP can discuss this in detail. Good luck on your journey. Darlene

Hi again, I agree with them. the others that have written. is medicare your only and primary insurance. you do have the co-morbid obesity health issues that warrant the surgery. good luck KEEP PUSHING. I did and now my suragery is 10 days away. Annrenee

Hello all. The Medicare requirement is new this year. It is specific to Tennessee. Each carrier can specify requriements for any procedure. Tennessee has lots of different ones for different procedures. They are called LMRP or local medical review policy. The one for Medicare states that you must have one of a list of related conditions, like diabetes or Hypertension. Also it does require detailed documentation of a 6 mos medically supervised diet including start and end date monthly weigh ins, documentation of whether the pt exercised and other details. Hope that helps. Jama