Question:
Does anyone know if Medicare/Medi-Cal will approve for WLS?

I have Medicare/Medical and am wondering if they cover WLS. I'm almost at the point to meet with a psychiatrist for evaluation then I'm told that I will meet with a surgeon. Just not sure if I will be covered. Thanks for your help.    — butterflygirl72 (posted on August 6, 2008)

August 5, 2008
my surgeon accepted my medicare. it will cost me about one thousand dollars out of pocket exspense. hope this helps
   — stevenzak

August 5, 2008
Hi Kari, My sister in law had Medicare in Florida and everything was cover except the drink the DR. wanted her to use just before the surg. I would contact the Medicare Office and ask what they require for the surg in your state. When she did here they told her everything she needed to have to request the surg. I hope it all works out as you want. Julie
   — tootsie52

August 5, 2008
I had WLS in March 2008. The key here is if your doctor accepts Medicare. Medicare will pay if he does if you meet the guidelines for Medicare. You must have a BMI of at least 35 and have at least one other co-morbidity, i.e., diabetes, etc. My surgeon did not accept Medicare, but the hospital did, so Medicare picked up the charges there. I am now waiting for TriCare4Life to pay the doctor's charges. Hope this helps.
   — ShirleyF

August 5, 2008
I have medicare medicaid in the state of CT. My docotr accepted the medicare and I think medicaid picked up some due to the medical issues I had from my obesity. (high blood pressure, diabetes so on) Best of everything to you
   — Lynnmon

August 6, 2008
I have Medicare in Texas. I'm due to have my lapband on the 12th of this month.. just a few more days. After going through almost a year with my "patient advocate" who is supposed to handle all of the pre-approvals and approvals with insurance, medicare does cover the surgeries however there is a process. You do have to go through the 90 day program. Done. Meet with diet, pysch, and excercise-done. Meet with your surgeon before and after these appointments. Done. But I just now found out, after being told, "oh, if you're here, you're approved" That's not really all true. You have your surgery done, everything is submitted, and at least here in Texas, Medicare will more than likely deny the initial claims. Then you have to rely on the the insurance biller and handler in the office to resubmit and file the appeal- while you are getting the letters for all of this - and pray that they are stating your case appropriately to get it approved the second time. NOW, more than likely it WILL be approved upon the second submission. Everyone wants to be paid, that's the job of the billing clerks and specialists is to get it paid and approved. so far, my office as gotten over 550 paid and approved Medicare patients. But be warned there are no upfront approvals like other insurance companies. But this is why you've probably filled out tons of surveys and forms asking what your health problems and BMI are/is. Best of Luck to yOU!!!
   — TexanLuvy

August 6, 2008
I HAD MEDICARE IN GA. AND IT COVERED ME BUT I HAD TO PAY $ 2600 CO PAY. YOU WILL NEED TO ASK YOUR DOCTORS BENIFIT COORDINATOR FOR THE ANSWER IN YOUR CASE.
   — cecilie

August 6, 2008
I have Medicare A & B, they have covered everything associated with the surgery but the surgeon's fees. I am still trying to find out why they have denied them. I think its funny that they paid the hospital, follow-up visits, and everyone else but the surgeon and assistant. Terri
   — ericson414

August 8, 2008
I have Medicare and Medicaid in Massachusetts and my RNY in Oct. 2007 was covered fully. If you qualify due to medical co-morbidities and BMI I think you will be covered. Check with your doctor or hospital. They will give you the best answer. Jane
   — NanaJane