MikefromCO

Medicare has changed a LOT in the past couple of years. A person I know had the Lap Band in 2008 and had to jump through a lot of hoops. A documented 3 month pre-op diet, a lot of trying to get the surgery approved. So, with that mindset, I stated that this might happen before the end of the year. However, Medicare has changed a lot. I did not need a supervised 3 month diet. I had records of my weight for the past 3 years and, I have no idea why, but the bariatric surgeon's office stated this information they received precluded me from having to go on the 3 month supervised diet. I thought getting the surgery approved through Medicare would be a nightmare, but it wasn't. It seems, as I stated before, Medicare deems it more beneficial to pay for weight loss surgery than the complications from obesity. Like quadruple heart bypass surgery, or in nursing home stroke care. I am 66, went to the orientation for the surgeon I chose in July. I did, myself jump through hoops getting all the needed paperwork to the surgeon's office. One has to do a lot of this pre-op paperwork on their own. So for 2 weeks I sat on the phone asking that my medical records be faxed to the bariatric surgeon's office, I did go to my doctor to get a letter of medical necessity. I did have a psych eval done which lasted all of ten minutes, and this coming week I need to get an upper endoscopy done. Actually, the one hospital in my area..the Clearwater/St. Pete area has one hospital that has is a Center of Excellence. And they are booked by so many bariatric surgeons because of this reason. Medicare also doesn't require this either. Therefore I am going to another hospital closer by. The pre surgery diet starts around August 26th, and the surgery is scheduled for Sept. 9.

WOW!!! Thank You Lene716,

This sounds even more encouraging. I appreciate the update.

Mike

Medicare does pay for the sleeve and the bypass. You have to jump thru all the hoops like regular insurance. I didn't use my Medicare on my surgery, I just used my husband's insurance. His insurance didn't require a six month diet or a psych evaluation. All I needed was to be over 18, bmi of 40, and bariatric center of excellence. Medicare requires all that stuff.

Thank you Jtickle,

There seems to be some kind of regional variation on the gastric sleeve. According to the folks at Exempla/St Joseph in Denver, Medicare only covers Banding and the bypass in this area. However, it never hurts to ask then to check again.

If the surgery costs a bit more, that will be OK.

I appreciate all of the wonderful input. It sounds like it's going to be an uphill climb just to get into the operating room.

There are some very well thought of Bariatric surgeons in Denver. You can't go wrong with any of these surgeons. They are all excellent.

Dr. Doru Georgescu, http://www.denverobesitysurgery.com/doru-i-e-georgescu.html (removed my gall bladder)

Dr Frank Chea http://www.skyridgemedcenter.com/conditions_we_treat/bariatric_surgery/meet-our-medical-director.htm (in my network)

Dr Tom Brown http://coloradobariatric.com/staff/thomas-r-brown-md/

Take Care & Thanks Again.

Mike

That is the order of which surgery he would prefer having as I read it.

Perfect! I apologize for the confusion. The sleeve rates #1 on my list followed by banding as #2. Medicare only authorizes (in CO anyway) Banding or Gastric Bypass.

(additional item)

Also, as much as I respect Dr. Alverez's work. Mexico is out of the question as any side effects would not be covered.

Hello,

Just discovered this forum. I'm an old member on Cruise Critic and Trip Advisor as well as photographic forums.

I'd appreciate your input on the following demographic info. How much of an uphill battle will this be?

Preferred Procedure: Gastric Sleeve followed by Banding

Medicare Covered procedure: Bypass and Lap-Band

Would like completed before Thanksgiving

Age: 68

Weight +120

BMI 46.4

Insurance: Medicare and UHC Medigap

Currently working in IT leadership

Gall Bladder (in a jar)

Long documented past history of Medical and other interventions for weight issues.

General Health: will be perfect if I drop the weight. Co-morbidity of hypertension.

My prior MD was rather small minded. He would not approve me for surgery the first time I asked. He said I couldn't follow through based on my history. Of course, his clinic booted all Medicare patients that would not use recommended advantage plans. My new Doctor is much more outcome oriented.

Thank You

Mike