Question:
"Now, I am told that Medicare won't cover OPEN RNY " HELP!!!!!

Question: "I was so excited after through research on the best procedure and then finally decide to do the roux-en-y gastric bypass." I Decided on a surgeon in my area. (Tulsa, Oklahoma) "Now, I am told that Medicare won't cover it. I noticed that others had approval through Medicare, What do I do now?    — Victoria B. (posted on August 6, 1999)

August 6, 1999
You do like some of us did...you get your doctor to say he/she feels you are a candidate for the surgery and you start at the beginning of the chain. You appeal. If they say no, then you appeal to the next authority....and up the insurance chain you climb. I believe that you said you are on Medicare. In my state, Pennsylvania, I choose Advantra which is a Health America ~ HMO for Medicare/Disability. First my appeal went to the downtown office - denied. At the bottm of the denial letter they tell you what steps you can take if you do not agree with their decision. My next appeal letter went to the state level...denied. They again told me how to appeal if I did not agree with their decision. My next and final appeal went somewhere in New York. It was approved. It took from February till June for the local Advantra to answer me. We sent the state a letter in August. The state, after their denial, forwarded our letter to New York. October, New York sent me a letter saying I was an excellent candidate for the surgery and that it was approved. Took about nine months. I think they put all these road blocks in our way so that we get tired of the fight and quit. Don't give up. It was worth the wait for me. It let me know how important this was to me and how much I was willing to make it work in my life. I scheduled the surgery for January 11th. I wasn't nuts. I went out in style. Put on another #!#??!? pounds, ate what I wanted for Thanksgiving and the Christmas Holidays. I thought that I would never again be able to enjoy a holiday with my family and friends in the same way again. Easter, Memorial Day and the 4th of July proved me wrong. Easter was a little strange. But I had a bite or two of everything. It took a long time, but it turned out to be a good thing because it slowed my whole family down and we enjoyed the food and time together. I know it sounds a little corny, but the cooks always complained that no one could possibly appreciate all the work they did when everyone was done eating in 20 minutes! Even the die hard sports fan stayed at the table...conversation sort of just took over. Strange. We still talk about it. Well, I have lost 120# plus since that date and I am still losing. I am also very happy with my choice. It is not a walk in the park. I have to work at it every day. Eat enough of the 'right' things...drink enough water...take my vitamins...walk a little further today than I did yesterday... If you need any help...drop me a line. Good luck.
   — Wendy Sue D.

August 23, 2002
Yes medicare will pay for this type surgery, medicare is a pe-approved insurance for this surgery, I have medicare and the day I went in for my consultation they set me up a surgery date. Surgery Date: 1-14-02, Pre-op: 369, Post-op 245, Total Loss 124lbs, Today's Date: 8-23=02
   — Brenda J.