Anyone familiar with Medicare?

[Menelly 56]

I'm trying to figure out the requirements to have VLG (I think that's the abbreviation?) covered by Medicare. Anyone familiar? Thanks!

[marfar7 1,528]

I think Medicare differs from to state to state (or so I've heard). My lapband was covered in 2009 and more recently (10 mths ago) my sleeve revision was also covered. I think my requirements were a bmi of >40 with no co morbidities or >35 with at least 1. My bmi was 40.2 plus I had hypertension. After 3 yrs and losing over 100 lbs, my lapband slipped. After a yr of conservative treatment (unfills/fills/tweaks) it finally herniated. During this year I gained 30 lbs, making my bmi 28. hey approved my revision becuz I guess Medicare recognizes that obesity is a lifelong disease and had I just had my band removed, I was most likely going to gain it all back.

The insurance coordinator at my drs office told me that medicare doesn't preauthorize, however. If u meet the requirements, it's safe to say they will cover it, but I wouldn't know for sure till afterwards, when they were billed. I was pretty nervous about having to pay for it but they came thru for me. Had to pay 10%.

Oh,, and I lived in Or at the time of both of my wls's. Not sure why a Federally run program varies from state to state, thats just what I've heard on this board...

Good luck!

Edited May 29, 2014 by marfar7

[Krystal0528 118]

My mom had the bypass done and a Tummy Tuck both paid be Medicare. She can awnser any questions you may have, just give her a call. Her name is Linda an her number is below;)

Edited May 31, 2014 by Krystal0528

[marfar7 1,528]

My mom had the bypass done and a Tummy Tuck both paid be Medicare. She can awnser any questions you may have, just give her a call. Her name is Linda an her number is below;)

979-292-4142

Not sure if it's a good idea to post ur moms number on a public board. It's one thing to post ur own, but not someone elses...

[Krystal0528 118]

I asked her first. She's sitting right beside me now. I'm in hospital had my surgery yesterday morning, an I will get released in morning. She says she has no problem talking to awnser any questions u or anyone might have.

[Jersrose43 837]

I think Medicare differs from to state to state (or so I've heard). My lapband was covered in 2009 and more recently (10 mths ago) my sleeve revision was also covered. I think my requirements were a bmi of >40 with no co morbidities or >35 with at least 1. My bmi was 40.2 plus I had hypertension. After 3 yrs and losing over 100 lbs, my lapband slipped. After a yr of conservative treatment (unfills/fills/tweaks) it finally herniated. During this year I gained 30 lbs, making my bmi 28. hey approved my revision becuz I guess Medicare recognizes that obesity is a lifelong disease and had I just had my band removed, I was most likely going to gain it all back. The insurance coordinator at my drs office told me that medicare doesn't preauthorize, however. If u meet the requirements, it's safe to say they will cover it, but I wouldn't know for sure till afterwards, when they were billed. I was pretty nervous about having to pay for it but they came thru for me. Had to pay 10%. Oh,, and I lived in Or at the time of both of my wls's. Not sure why a Federally run program varies from state to state, thats just what I've heard on this board... Good luck!

Medicaid differs state to state but medicare is federal and one set of rules nationally.

That said I don't know the regs but lots of folks on this forum were covered by medicare

[marfar7 1,528]

I think Medicare differs from to state to state (or so I've heard). My lapband was covered in 2009 and more recently (10 mths ago) my sleeve revision was also covered. I think my requirements were a bmi of >40 with no co morbidities or >35 with at least 1. My bmi was 40.2 plus I had hypertension. After 3 yrs and losing over 100 lbs, my lapband slipped. After a yr of conservative treatment (unfills/fills/tweaks) it finally herniated. During this year I gained 30 lbs, making my bmi 28. hey approved my revision becuz I guess Medicare recognizes that obesity is a lifelong disease and had I just had my band removed, I was most likely going to gain it all back. The insurance coordinator at my drs office told me that medicare doesn't preauthorize, however. If u meet the requirements, it's safe to say they will cover it, but I wouldn't know for sure till afterwards, when they were billed. I was pretty nervous about having to pay for it but they came thru for me. Had to pay 10%. Oh,, and I lived in Or at the time of both of my wls's. Not sure why a Federally run program varies from state to state, thats just what I've heard on this board... Good luck!

Medicaid differs state to state but medicare is federal and one set of rules nationally.

That said I don't know the regs but lots of folks on this forum were covered by medicare

That was what I said when I first read that. But, I'm sure it was Medicare everyone was talking about. I mean, I knew it was what I had, and I don't have Medicaid.

I thought it was weird that it being a federally funded insurance that it was different...

[#9grammy 274]

Thanks for the info on Medicare, I've been looking for someone who is on it. I have to go through many of the tests before they will approve it. The drs office called Medicare and they said I would be responsible for the 10% which is about 1,200. I also have Tricare for Life but they don't cover wls. Unless your bmi is 40.

Good luck with your surgery, I have to wait the 6 months, bummer. I was so worked up for having it sooner

[Jersrose43 837]

#9grammy. Isn't medicare an 80/20 plan? I don't think it's 10 unless you have a supplement

[#9grammy 274]

#9grammy. Isn't medicare an 80/20 plan? I don't think it's 10 unless you have a supplement

I personally haven't talked to Medicare, this is what my drs office called the billing and they said the amount. I also have Tricare for Life but they won't cover it.

[Thinkingthinner1109 485]

Medicare pays 80 percent after the deductible. Medicaid patients usually don't have to pay anything.

[Cococat 119]

I will be having the sleeve in Sept. If you are in Medicare (age qualified) and want to know what qualifies you for Medicare approval, Google: "Medicare, bariatric surgery." There should be a list of co-morbidities that if you have (3 on a list of seven or eight) qualifies you to be covered by Medicare. CHECK FOR YOURSELF. Things change, as we all know. For all I know, their requirements may have changed by the time you read this!

My family doctor and my arthritis doctor were all gung-ho that I get this surgery.

My bariatric doctor's office was very helpful in going through all the Medicare things with me. I believe that my sleeve procedure will improve my health and be cheaper for Medicare in the long run.

Funny, but at the point where I said to myself, to heck with the cost, I need this surgery, I found out Medicare will cover it if you qualify.

Advice: Check to see what the requirements are. You may be pleasantly surprised. Your bariatric surgeon and his staff have been through it before and can give you the best advice.