Question:
Did medicare require anyone having or has had RNY to have 18 months of diets

I was told that medicare requires 18 consecutive months of documented diets. I don't have 18 months to wait. I have disibilty medicare/wellcare. My PCP sent in a medical necessary letter to wellcare(11-11). Still waiting on an answer. Would like to find out how others got medicare to pay.    — yellow T. (posted on November 17, 2004)

November 16, 2004
When I had my surgery done last year, medicare was not requiring a lengthy diet history. All that you needed was proof of medical necessity (which your doc has provided). You can go directly to medicare's site online and see what they cover. I do know that they do not pre certify before surgery, so you have to have the proceedure then they decide if they are going to pay. I didn't have a problem. I think the fact that a surgeon would perform the surgery on you is enough to prove that is was necessary and they would cover it. Good luck in your journey to the losing side. Lisa lap/rny 10-23-03 340/181/??? -159lbs
   — Lisa H.

November 17, 2004
Medicare does not require 18 months of diet history...they don't even require pre-authorization as long as you have a co-morbidity such as high blood pressure, diabetes. The most any insurers are requiring is 6 months of consecutive weights with your PCP and documentation of obesity, and treatment.
   — Debi R.

November 17, 2004
I have Medicare and I didn't have to do anything except go to the surgeon , do all the testing and get the surgery. Medicare pays after the fact.......Read my profile
   — cindirella

November 19, 2004
I was told from medicare & the surgeons office that medicare now requires 18 months of documented diets. I have not tried to go any further with medicare. The surgeons office will not make an appointment with me until I have the diets. I also have wellcare of FL & everything has been sent to them. Everything looks good so far. They are now asking for the surgeons name & the hospital that I will be going to. So please pray that they approve me!!
   — yellow T.

November 20, 2004
i had my surgery on aug 24th and medicare did not ask for anything my dr just sent in the paper work and they paid for all of the surgery and hospital bill but my deductable janice
   — bopper