Question:
Special Requirements according to doc for Medicare approval

I was on a site yesterday doing research in the San Diego area for Medicare/MediCAL acceptance in the area, and I noted the doctor said Medicare had special requirements for approval. I am 5'7'' and 282 (that's a BMI of at least 44 I'm certain) and I was unaware there was any other requirements if you were insured with Medicare than to have a BMI of 40+ with no comorbids or a 35 w/comorbids. Does anyone know anything contrary to this?    — hibou21 (posted on May 7, 2003)

May 7, 2003
With medicare it just has to be medically necessary.....they don't preapprove it anymore.You have the surgery and then everything gets submitted for payment.Medicaid is different......all of the different medicaid plans have their own requirements.
   — jennifer A.

May 7, 2003
Your doc is wrong. There are no special requirements for medicare. They don't even pre-approve but it does have to be shown that it is medically necessary for them to pay.
   — Delores S.