I'm 68, been on Medicare 3 years, 6-5 and weigh enough to play nose guard for the Packers. Allright, 305. My first surgeon appointment is this coming week etc. BMI 37 with two co-morbs. My question is, has anyone else used Medicare for the LB surgery and studies? How does it go with them? Do you have to prequalify first or do you get it all done and then hope they pay like most things Medicare? Thanks for letting me know some insights.:laugh:

Hi.

I am using medicare. they, like most insurance had some requirements and I've met all of them.

You have to have a BMI of 35-40. If its under 40 you have to have some co morbitities. You have to have 6 months of non consecutive weights. Like Jan 05, April 06, and so on....

You have to have tried a lot of other ways to lose weight before....I had a long and dr documented history. You have to have your surgery at a bariatric center for excellence....you have to have a letter of medical necessity.

I had all of this information faxed to my surgeon because my doctors had been documenting everything for me for a long time. They had been recomending me have this surgery for two years before I was ready. Now my surgeon has the complete chart, and I am having surgery Wednesday. They will then send it all in to Medicare and the surgeons office staff knows what will work with each insurance company so they make sure they get everything right.

Hopefully, I will get a bill that says medicare paid their part.

Its a process.... just like everything.....

I called Medicare and asked them specifically what their requirements were before I saw my surgeon. Some people have to have a lot more things done....I was surprised medicare was so "lenient"....

Good Luck,

Meg

I'm also on Medicare - but chose a surgeon who did NOT accept it. So I was self-pay. However, I feel this band will help me return to health and vitality.

I Have Medicare plus AARP. As others said there had to be co morbities, which I have bad knees, acid reflux (a big co-morb.) fibromyalgia, irritable bladder and bowel, bladder leakage (yuck). The big one too was sleep apnea. What I am trying to say is be sure you tell the surgeon's office ALL problems you have, the more the better. I also had to be on a 6 month supervised diet by my (PCP), which went by pretty fast and wasn't bad at all, I just did what I know I should do. I also had to go through sleep studies and different tests most of which were deemed necessary by my surgeon. All in all it went fast, I am now 3 weeks post op.

Good luck and hope you turn into a cheerleader instead of a football player!!!