Super Stressed about Self-Pay and Medicare. Help Please.

[FreeToBeMe 2]

Hi All,

I want to put this on this board because it gets more traffic than the Insurance Board.

I am currently scheduled to do a self-pay on December 2nd. Now, I am reading on different WLS boards that Medicare will starting covering the sleeve in January. In fact, some folks say they have already been covered.

So far I have hit a brick wall trying to confirm this. The Medicare phone reps have no idea, my surgeon's office doesn't either and I have Googled it to no avail.

I really need suggestions about whom to contact to see if this is true. Are there any Medicare advocacy agencies that might know? I really feel in a bind and am on the verge of postponing my surgery.

Thank you so much for you time.

Pennie

[Tiffykins 672]

The only thing I've heard about Medicare covering the sleeve (here in Florida) is that they require an 18 month pre-op supervised diet just like the require for the lapband or RNY surgeries.

I have not seen any articles or notifications on Medicare covering the sleeve. I checked on OH, but didn't find anything either.

I hope someone else can pipe in and give you a better idea on if they are truly going to approve the sleeve.

[Margie 0]

Did anyone find out if Medicare would pay for the surgery?

[Bona Fide Diva 3]

I saw this...https://www.noridianmedicare.com/provider/updates/docs/Bariatric_Surg_Coverage_acro.pdf

I was also told that this is the "umbrella" for what CMS will and will not cover so I guess the answer is no.

[ic4rest 0]

Is it possible to try billing the preop and surgery to Medicare to see what they pay or if they pay? If they don't then you are self pay???? Just a thought...

[ic4rest 0]

One more thought...

I would think for Medicare to pay you need to go through some kind of authorization process similar to most other insurances. Can you try to get authorization for the surgery to see what they say?

[Margie 0]

Thanks for everyone's input. It looks as if Medicare still will not pay. Rats..

This is the surgery my doctor recommends, but I can't pay the cost. I have talked with people who have had it done it Mexico, but I am too high risk. I am going to try and talk with someone in Medicare's utilization review and see what the status is on getting it approved. Problem is nothing moves quickly when it somes to these processes.