Question:
i am on medicare, i have diabetes that is controlled with diet and exersize---
sometimes not so good, i also have osteoarthiritis, i am 150 lbs overweight,,,, does this quaalify as a co morbis condition, and can anyone give advice on getting medicare to approve me for lapband surgery??????? — sherrymccoy@bellsout M. (posted on February 18, 2007)
February 18, 2007
I would think it does. I have arthritis as well and am almost 130lbs
overweight. I would get a letter from your doctor stating that this
surgery is nessaccary.
— hugger1021
February 18, 2007
Hi, you sound like a carbon copy of my problems. L also have type 2
diabetes as well as periperhal neuropathy from the diabetes, ostearthritis,
and I'm on Medicare. I had the lapband done on Dec 4th 2006. There is
nothing that you have to qualify for, you're already qualified, the only
stipulation is that you have to have the lapband done by a Doctor that has
the Center of Excellence certification and Medicare will pay for it. You
can find a Dr. with this certification right hear on OH.com, just look at
the top of the page and click were it says, find a bariactric surgeon. Good
Luck.
Dan
— bigdooba
February 18, 2007
You need to get in touch with your primary care giver to get started with
the process. Make an appointment and go in and talk to your Dr. about what
you want to do. He or she will get you started. If you want someone to chat
with contact me. njkbutton I am willing to chat on site.
— njkbutton
February 18, 2007
— Jolly
February 18, 2007
I too am on medicare, It is my understanding that as long as you see a
Surgeon that is approved my medicare, and have a co morbidity you will be
approved. It should not matter that your diabetes is controlled by diet and
exercise. Here is a link to the Medicare site, You can punch in your state
and it will tell you who is covered in that state.
http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage
Hope this help.
Phyllis
— Phyllis H.
February 19, 2007
Both diabetes and osteoarthritis are considered co-morbidities. I have
osteoarthritis due to 20 years of morbid obesity, and I was insulin
intolerant prior to my RNY two years ago, although I was never labeled
"diabetic" in my medical records. As a matter of fact, I had my
first and only insulin injection while in the hospital for my RNY. My PCP
was instrumental in wording my surgery request so that it was deemed
medically necessary. I had lots of hoops to jump through, and considerable
out-of-pocket expenses, but I was eventually approved. My insurance is
Group Health, and while I can't give you any advice concerning Medicare, I
can say that many insurances will approve your surgery if you have a
clever, intelligent and supportive PCP on your side. Good luck!
— buglebird
February 19, 2007
I just had RNY done on medicare and guess what?? It only took me 3 mos
exactly from my first appt with doc til my surgery date..they are quick to
approve but you will have standard co-pays .. good luck..
— Sherri624
February 21, 2007
I'm on Medicare in Ky and I know that they have approved the lapband here,
so I would say probally so. I go to the Doctor to set things up March 23
rd. and I went to the first appointment with the therapist and talk to
them and it paid all of it.. They told me it wouldn't pay $100.00 of it
that I'd have to pay that and I did, but medicare sent me a conformation in
about a week and they paid all of it and I'm -$100 to the doctor now. So
I'm sure they will. Good Luck.
Lydia
— lbutts
February 22, 2007
I am on medicare and have been worried sick that i wouldn't get approved.
I had a sleep study done and not to my surprise, i have sleep apena - i am
about 140 overweight. I called my surgeons office and they said i'm all
set :) 1 co-morb, bmi greater than 35 and dr says it is medically necc. :)
good luck i think you will have NO probs!! OH - Make sure the surgeon you
choose has a hospital that is already approved as a center of excellence.
My dr has been waiting on his hospital to be approved since last April.
Even though i just found out that it's pretty much a go - i can't get it
done until the hospital is approved, so i am seeing a surgeon today who
works out of a hospital that is already a center of excellence. :)
— [Deactivated Member]
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