Question:
Has anyone EVER received coverage by Medicare?
I have been very frustrated trying to figure out if Medicare would pay for this surgery. The Medicare office and some WLS members say that they won't - however - I have noticed that a few members have said that they were covered <very confusing>. Does anyone know of a surgeon that will create and individual payment plan if they are self pay? Any emails would be appreciated - I am very desperate!! — Lisa H. (posted on October 18, 1999)
October 18, 1999
Lisa, We have had many Medicare patients - they do pay. There is no
pre-approval process. I believe general guidelines are: 100# overweight,
1 co-mordid, letter of support from your PCP and a psyche eval.
— Debbie T.
October 18, 1999
My sister is 100% disabled, and has medicare. Her husband works
and has insurance on the whole family. This was her primary insurance,
however, Medicare did pick up the balance. As long as it is deemed
medically necessary, they will pay... to my knowledge anyway. She got
pre-approval from both before having surgery in July. Good luck,
— Lori D.
October 18, 1999
Medicare did cover my surgery, I had co-morbidities, arthritis, back
problems, depression due to the weight, and an eating disorder. I found a
surgeon who accepted medicare, but it took 6 months of searching. I also
have Medicaid as a secondary insurance.
— Angel G.
October 18, 1999
Yes, Medicare will pay for the WLS surgery if you meet the
requirements of their morbid obese criteria, however, does not give
pre-approval. I am using Right Weight of Tenn. and so have others on
Medicare.. We all sailed through approvals with little to no resistance.
Good luck E-mail me if you have more questions.
— Victoria B.
October 18, 1999
Medicare is odd. They don't do precertifications. They reserve the right
to reject the claims afterward.
The surgeon has to present his case, appeal once, appeal twice, then
request
a trial. Then they back down and pay, if their are co-existant
co-morbidities which
the successfull treatment of obesity would ameliorate. Diabetes, heart
disease, hypertension, sleep apnea,
get them documented before the surgery.
— Bruce B.
October 18, 1999
Contact: Bariatric Specialist of Mich
1-800-282-0066
they are out of Ann Arbor Mich.
they can answer all your Questions about payment and getting coverage. If
800 number does not work from your location here is the direct number.
734/997-8402
Good Luck ; Julie
— JULIE S.
October 18, 1999
Medicare was my Primary insurance and I had no problem getting them to
approve.My surgeon sent them a letter explaining the need and a letter also
to my secondary insurance and bingo 4 weeks later I was post-op.....
— pam.leach
October 26, 1999
I had my WLS on April 7, 1999 and Medicare paid for it. Regency BC/BS paid
for the rest.
— [Anonymous]
February 2, 2000
Dear Lisa, I just saw your question about Medicare. My surgery was paid
for 100% by Medicare. There is no pre-approval. I only had to pay the
$768.00 hospital deductible and 20% co-pay for my pre-op hospital testing.
Should you have any questions or you would like me to refer you to my
surgeon please e-mail me privately at [email protected]. Good luck!!
— [Anonymous]
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