Question:
I need definition of requirements including age limits for medicare

Can we get any written criteria from medicare that absolutely denies or accepts advanced (69) years of age for this surgery. They don't seem to have any trouble doing heart and lung major surgeries and I wonder if they have a right to decline coverage for overweight women who will be in worse physical shape from all the problems related to morbid obesity. Any help anyone can give me would be appreciated.    — Ruth K. (posted on April 28, 2000)

April 28, 2000
Medicare does not impose any age limits on this surgery. Also, one good thing about Medicare is that you do not need preauthorization to have the surgery done. The bills are submitted after the operation along with the reasons for the medical necessity for the operation. The doctors assume an element of risk if they agree to accept Medicare insurance and of course be absolutely clear, in writing that if Medicare does not cover the surgery you will not have to pay any charges for the operation. This is why most doctors do not accept Medicare patients and most of the doctors who do accept Medicare patients are affiliated with public hospitals and universities (bottom line is the almighty dollar and doctors in private practice are more in control of their incomes and fees and revenue). I have Medicare and my doctor charged $11,000, Medicare approved $1,503.38, paid the doctor $1,202.70 leaving me a balance of $300.68 The doctor must agree to accept Medicare assignment and of course the portion charged to you is negotiable, $300 is certainly not too much and sure beats self pay. Don't get caught up in the what if's and unknowns about Medicare. Talk to billing offices directly to get exact figures (though not patient names, of course) and you will see what expenditures you would have. Lastly, get going and find a Medicare facility and get on with your decision. Medicare is great, much better than dealing with many insurance companies. They pay for WLS, it is not experimental as some companies try to weasel out!! 68 is not too old, ask some of our 60 year olds who have had this surgery(Some doctors impose age limits for their criteria but that is not Medicare)>
   — Fran B.