ANY HELP PLZ!

HELLO EVERYONE I'M VERY NEW TO THIS WHOLE THING BUT CAN'T WAIT UNTILL I START THE PROCESS FOR THE WLS IM 26 BEEN BIG ALL MY LIFE AND HOPING TO GET AN APPROVEL DID ANYONE HAVE MEDICARE AND HAD IT DONE DID THEY PAY FOR IT IF SO PLEASE LET ME KNOW WHAT I'M LOOKING FORWARD TO BY GOING TO THEM FOR PAYMENT OTHER THAN THAT I HOPE TO REALLY MAKE FRIENDS I LIVE IN THE COLUMBUS,OHIO AREA ANYONE FROM THERE PLEASE LET ME KNOW WELL HOPE TO HEAR FROM SOMEONE SOON

No Medicare.  Blue Cross Blue Shield Minnesota.  The plan I was on at the time had a $500(?) deductible with 80%/20% coverage with an $1800 out of pocket yearly max.  Plus, surgeon's office had a $300 charge not insured (I thhink it was for the dietician).  So I paid my $2100, and haven't looked back. OK, that was a long story.  I just wanted to welcome you to the community.  Enjoy it here, and best of luck on your WLS journey!

Welcome to the WLS in your 20's Forum! There's a whole bunch of people here in all stages of the process to share your questions and answers with and have fun.  I didn't have Medicare, I had United Healthcare. I did a little bit of research though and I think I got the jist of it. I'm by no means an insurance expert though, so I would highly recommend speaking to the insurance specialist at the surgery clinic you have chosen. If you haven't chosen one, you could try getting ideas from the folks on the Ohio local forum or searching for an American Soceity of Bariatric Surgeons Center of Excellence at their website: http://www.asbs.org  It sounds like in Ohio Medicare will cover 80% of the cost for lap or open rny, lap-band, or duodenal switch surgeries as long as you have the surgery at an approved center or ASBS Center of Excellence. It also sounds like in order to be eligible you will need to establish that the surgery is medically neccesary. It sounds like to do this you must have a BMI of over 35 and at least one co-morbidity such as diabetes, sleep apnea, or high cholestorol. The document that lists all of the requirements can be found at: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=11361&lcd_vers ion=30&show=all Most insurance companies from what I have heard don't require a co-morbidity for approval of those who have a BMI of over 40, so I would defianatly check that out if you don't have any documented co-morbidities. One more word of advice - even if you have never been diagnosed with any of those co-morbidities it doesn't neccesarily mean you don't have any. I didn't even know that I had Type II Diabetes AND Sleep Apnea until after my doctors tested me for them as part of the pre-op medical approval process. Good luck and I hope this helps! You might want to post this question on the main forum too - more people will see it and you are bound to get a couple of responses from people who did use medicare that way.

OK, so this was bugging me so I called the insurance guru Beth at my clinic (Duke)...she said that if your BMI is over 40 then Medicare does not require a co-morbidity for approval - they only require it for patients whose BMI is between 35-40...Also, she did unfortunatly add that they do require patients to undergo a six month physician supervised weight-loss program before being approved. It doesn't matter though how much weight you do or do not lose during that time - the BMI they use to consider is the one that you are before the diet begins - it is just another hurdle they force people to go through so that some of the less determined patients won't go through with it thus reducing their costs. Pre-op weight loss also can make the surgery much safer which is good for you and their costs as well since lower complication rates means lower costs for them too....hope this helps...

OOO mike thank you so much this helps alot alot even that my bmi is over 40.0 then i should be just great but far as the diet goes i have old paper work showing that it doesnt help when i try ill lose the first two weeks then i would start gaining right back so that just made my day thank you so much

i don't know if medicare variesby state, but when i had mine in new jersey of '05 i did not need any co-morbidities, just a BMI over 40. Also i did not have to wait for approval, as long as my doc deemed it necessary. They covered 80% but i also had medicaid so they picked up the rest of the bill. All i had to do was pay my doc for post op support group fees which came out to be $750. i don't know if this helps, but i would def. ask ur doc what is required.  Good Luck!!

THANK YOU THIS IS VERY HELPFUL BECAUSE I HAVE THE SAME THING BOTH PARTS OF THAT THANK YOU I WILL KEEP EVERYONE IN TOUCH WITH EVERYTHING THAT HAPPENS