Re: medicare
2007-04-30 18:05:21Hi Keri,
I have been researching Medicare coverage myself since thats the only
coverage I have. They pay 80% and you pay 20% unless you have other
coverage.
I found the following National Coverage Determination on Gastric
Bypass at Centers for Medicare & Medical Services website:
NCD for Gastric Bypass Surgery for Obesity (Effective for services
performed on or after October 1, 1979) (35-40)
Publication Number
6
Manual Section Number
35-40
Effective Date of this Version
10/1/1979
Benefit Category
Physicians' Services
Note: This may not be an exhaustive list of all applicable Medicare
benefit categories for this item or service.
Coverage Topic
Hospital Care (Inpatient)
Item/Service Description
Gastric bypass surgery, which is a variation of the
gastrojejunostomy, is performed for patients with extreme obesity.
Indications and Limitations of Coverage
Gastric bypass surgery for extreme obesity is covered under the
program if (1) it is medically appropriate for the individual to have
such surgery; and (2) the surgery is to correct an illness which
caused the obesity or was aggravated by the obesity.
I spoke with Medicare on the phone today and you must meet those 2
requirements and there is no pre-approval. So more or less you have
the surgery and Dr. and Hospital will file claims afterward. You have
to meet your Doctors Guidelines before the surgery will be done. I
also know that you have to be at least 100 lbs. overweight and have
blood tests, etc. done beforehand.
Also you can't just choose your own Dr. The Dr. has to accept
Medicare. I researched WLS and chose 2 surgeons that were highly
recommended in my area only to find out that they do not accept
Medicare. Not to many Bariatric Surgeons accept Medicare.
I am waiting on appointment with a surgeon that does accept Medicare
and I will know more afterwards.
I wish you luck on your journey. Hope this helps you.
Chris
Pre-op
280/ /150