Questions for a friend of mine.
Hello All,
My name is Tanya and I'm new to this board. I have been lurking for quite some time but I haven't ever posted on this site before. I'm starting the gastric bypass process this week. I know that my insurance will approve the surgery, my problem will be getting healthy enough to survive the surgery. That is a completely different and long story.
My question is for a friend of mine. She is 53, weighs 255lbs, 5'5, and is suffering from degenerative joint disease, swelling, gerd, and several other small things. She suprisingly doesn't have hypertension. Her BMI is over 40. She is currently on disability and has medicare. She saw a surgeon in our area and was told that she doesn't qualify for the surgery. She wasn't given a reason why, just that she didn't qualify. She called medicare and was told by them that she had to have a BMI of more than 40 and hypertension to qualify for medicare to pay for this. My question is, has anyone else with medicare had gastric bypass or lapband surgery without hypertension? There are so many other problems that come from being obese that has nothing to do with hypertension.
Also, she is on disability for a nervous condition. She takes several nerve medications. Could that be why the surgeon denied her? I'm new to this and from what I have read, alot of these bariatric surgeons are squirrely people. Alot of them seem random with when it comes to their qualifying process. She is severely depressed with her weight and is ready to give up. I encourage her as much as I can but I know all to well about the depression that comes with obesity.
If anyone has any information about medicare or how to qualify for gastric bypass or lapband with medicare in Tennessee, I would greatly appreciate. This is such a wonderful lady and has overcome so many obstacles in her life already. If anyone deserves a chance, it is her.
Thanks
Tanya Sparks
My name is Tanya and I'm new to this board. I have been lurking for quite some time but I haven't ever posted on this site before. I'm starting the gastric bypass process this week. I know that my insurance will approve the surgery, my problem will be getting healthy enough to survive the surgery. That is a completely different and long story.
My question is for a friend of mine. She is 53, weighs 255lbs, 5'5, and is suffering from degenerative joint disease, swelling, gerd, and several other small things. She suprisingly doesn't have hypertension. Her BMI is over 40. She is currently on disability and has medicare. She saw a surgeon in our area and was told that she doesn't qualify for the surgery. She wasn't given a reason why, just that she didn't qualify. She called medicare and was told by them that she had to have a BMI of more than 40 and hypertension to qualify for medicare to pay for this. My question is, has anyone else with medicare had gastric bypass or lapband surgery without hypertension? There are so many other problems that come from being obese that has nothing to do with hypertension.
Also, she is on disability for a nervous condition. She takes several nerve medications. Could that be why the surgeon denied her? I'm new to this and from what I have read, alot of these bariatric surgeons are squirrely people. Alot of them seem random with when it comes to their qualifying process. She is severely depressed with her weight and is ready to give up. I encourage her as much as I can but I know all to well about the depression that comes with obesity.
If anyone has any information about medicare or how to qualify for gastric bypass or lapband with medicare in Tennessee, I would greatly appreciate. This is such a wonderful lady and has overcome so many obstacles in her life already. If anyone deserves a chance, it is her.
Thanks
Tanya Sparks
Tanya--first, congrats on your decision to have WLS...I had RNY with Dr. Houston on 3/17/09 & it has been an amazing experience...definitely no regrets!
I am so sorry about your friend, but I think it is so nice of you to take such an interest in her & be such a champion for her cause. I, unfortunately, don't know much about Medicare, but I am hoping that someone will come along soon & give you more information re: the qualification guidelines for Medicare and, specifically, the issue re: hypertension.
Until then, tell your friend to hang in there...where there's a will there's a way....if she wants this to happen it will.
Good luck to both of you. Take care, Micheala.
Preop Weight 293/SW 289/CW 202.3/GW 165/LW158
Denise M.
on 6/2/09 11:07 pm
on 6/2/09 11:07 pm
Hi Tanya and welcome to the board!
Good luck on your WLS journey and I hope everything goes well! Feel free to pop in at any time--the people here are amazing and a great resource! It was tough finally getting to the point of making the decision and following through with it, but I have no regrets and am happier and more energetic now than I have been ever!
As for your friend, I cannot speak about Medicare, but most insurances require a BMI of 40 OR a BMI of 35 and co-morbidities. Not hypertension specifically, thought it is one of them. For instance, I had a BMI of >40 and diabetes, sleep apnea, joint problems, high cholesterol, etc, etc, I wasn't worried about approval with that laundry list of problems. It was a no brainer that I'd save the insurance company money in the long run. Assuming I continue to work my tool to its advantage the rest of my life.
Hopefully someone with some specific info on Medicare can give her the specifics of their program. I do think it is obnoxious that they just said no with no reasons as to why she was denied.
Good luck to you both!
Denise
Good luck on your WLS journey and I hope everything goes well! Feel free to pop in at any time--the people here are amazing and a great resource! It was tough finally getting to the point of making the decision and following through with it, but I have no regrets and am happier and more energetic now than I have been ever!
As for your friend, I cannot speak about Medicare, but most insurances require a BMI of 40 OR a BMI of 35 and co-morbidities. Not hypertension specifically, thought it is one of them. For instance, I had a BMI of >40 and diabetes, sleep apnea, joint problems, high cholesterol, etc, etc, I wasn't worried about approval with that laundry list of problems. It was a no brainer that I'd save the insurance company money in the long run. Assuming I continue to work my tool to its advantage the rest of my life.
Hopefully someone with some specific info on Medicare can give her the specifics of their program. I do think it is obnoxious that they just said no with no reasons as to why she was denied.
Good luck to you both!
Denise
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