Question:
Is it true that Medicare makes you wait 6 months before they will consider paying
for Gastric Bypass or any other WLS? That seems like cruel and unusual punishment!!! — RosanneH (posted on November 1, 2010)
November 1, 2010
I got approved in 3 weeks and by the 4th I had surgery. Regarding ur
comment on other surgeries they will not cover any but the RNY Gastric
Bypass. At least thats what they told me.
— [Deactivated Member]
November 1, 2010
Most insurances make you wait up to 6 months. There are a battery of tests
and evaluations you must go through AND pass before anyone is considered
not to mention you MUST show a committment to the dietary end of it....i.e:
you CANNOT gain weight during the preop phase. It is not cruel and unusual
punishment but rather their way of ensuring you are both mentally and
physically prepared and strong enough to even make it through the surgery.
Hope this helps.
— karensaporito
November 1, 2010
I do not have medicare, but I had to wait one year and have documentation,
however, I am so glad I did. I was very informed about this surgery.
— FSUMom
November 1, 2010
I also forgot to mention that I needed to show I was on some kind of Dr's
diet, I didn't lose that year, but the Dr documented I was trying this
thing or that.
— FSUMom
November 1, 2010
I know that 6 months can seem like a long wait. I personally think it is a
good idea. It took me 2 years to prepare for this surgery. The surgery will
make you loss weight but you have to do the rest. There are a lot of things
that happen that you need to prepare for. Somethings that people tell you
about and other things that no one will tell you about. You need to deal
with why you gain the weight so you can keep it off. Now is the time to
start working out. Even if it is just walking for 15. min a day. Start
using lotion and baby oil. I think this helped my skin shrink. Start trying
to eat better. Read as much as you can about the surgery. Start taking your
vitamins. Last but not least ask question.
Good luck.
— dsquire
November 2, 2010
Hi,
It is my understanding as Medicare Benefits counselor that the waiting
period is mandatory. However as with anything, every situation is toally
different and Im sure there could be special circumstances. My clients that
have had bariatric surgery have waited the 6 months. Not as punishment, but
as a preparatory period to learn the proper eating routine and to make sure
their bodies are ready for the procedure. If you would like more
information you may call medicare directly at 1-800-633-4227. Hope this
helps.
— kchooker
November 2, 2010
I have medicare. There are things you need like a bmi of 35 or more, some
type of diabetes or high blood pressure and something else..you have to do
a 3 month supervised diet. I think the only way you have to wait longer is
if you have some mental issues like suicidal thoughts. I say call them.
They were pretty ok when I called and asked tons of questions
— That_816_Princess
November 2, 2010
I had medicare for my GB and did not have to wait at all for them to ok it!
— StlX
November 3, 2010
I had my pcp referral did all of the testings and got right in with
Medicare with out any problems had the needed requirements. I did better
with Medicare than a lot of people did with fancier insurances.
— Eveningblossom
November 4, 2010
Most insurance, Medicare included, makes you work with a physician for 6
consecutive months before they will cover your surgery. You need this time
to make sure you know what you're getting into. This surgery completely
changes your life in so many aspects and they just want to make sure you
are ready for that change. It's not "cruel punishment" and would
actually be considered cruel if they covered the surgery too early and
patients got it and were not ready for it. The first step is usually a
seminar, have you checked to see if there are bariatric surgeons in your
area? Good luck to you :)
— Clumsybarbie
November 9, 2010
Medicare does not require you to do no diet ! If your DR. says that it is
simply not true,your Dr.does not want to tell you, he is giving you time to
change your mind,and long waiting list.I have medicare,seen my Dr.in late
Nov. had my surgery the next month. If your Dr,will lie to you now,what is
he hide,in?
— rebecca W.
November 9, 2010
Medicare does not require you to do no diet ! If your DR. says that it is
simply not true,your Dr.does not want to tell you, he is giving you time to
change your mind,and long waiting list.I have medicare,seen my Dr.in late
Nov. had my surgery the next month. If your Dr,will lie to you now,what is
he hide,in?
— rebecca W.
January 4, 2011
Medicare has national guidelines and local guidelines. Sometimes these are
different. I live in Louisiana and the local intermediary goes by the
national which does not have any requriements other than 35 BMI with
comorbites and 40 BMI. There is no prior diets and no time limits.I do know
that Texas which is trailblazer has local determination that are different
from the national. You need to look and find out which FI is handling your
state and check their website and find out what the requirements are.
— martha1014
January 5, 2011
Hey there! I'm from Iowa and here we had to do a 6 month doctor supervised
diet prior to even sending anything in for authorization. But honestly, 6
months is not long to wait and its a good time to get into the right frame
of mind. I was told also that if you miss an appointment, or you go over
30 days between appointments, be prepared to start your 6 months all over
again. WLS isn't easy. It takes a lot of dedication and commitment. It's
so worth it! 6 months isn't a huge sacrifice to make. You can do it! I'm
excited for you!
— lady_myst
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