New Medicare Rule! Can"t Get My Fill!

DrewsLou · July 5, 2006

Leenerbups...

I am so sorry that you aren't getting anywhere with Medicare! I find it appalling that your doc will leave you high and dry now that you are banded and can't get a fill. That's pretty crappy if you ask me! The band won't work without aftercare and it seems your doc is forgetting that.

Have you called "the other doc" to see about a fill? What do they charge?

I sure hope things work out for you. I have read your posts for a while now and your sense of humor always makes me smile. :grouphug:

NeenBand · July 5, 2006

Good luck in your travails....you seem to hit all the Sargasso Seas in your journey....

heh, your so right jack. I wonder if chosing this pirate avatar was the smart move? ;-)

I really appreciate the support everyone is giving me here. It's pretty upsetting. I literally don't know what to do now.

Just to clarify to everyone, I can still see my doctor in his office etc, but fills and other procedures will not be covered by Medicare. So, if something were to happen, from needing an unfill to something more serious, I'm out of luck.

Thanks drewslou, I'm glad I can make you smile. :-)

Randi · July 6, 2006

Leenerbups and all Medicare bandsters, dont' forget to rant here: :yell: http://www.house.gov/ :yell:

I just got off the phone with medicare again, and you won't believe what they told me...to travel to one of the "Approved Centers of Excellence".
Oh right, just what people on Medicare can afford to do.

I called the hospital my doctor works out of and they have no idea when they will get this freaking insane Medicare Stamp of Poop that leaves so many Lap Banders across the country out in the cold. NO CARE!!

Medicare Banders you better think twice now.

I'm also very ticked off at the lack of help and caring all the way around for someone in my postion.

**RANT OVER**

Randi · July 6, 2006

Leenerbups,

Call the approved facility and find out which doctors use their facility to perform bariatric surgery. You may find that you have "doc options" you hadn't considered. I doubt they would go to the extremes of getting the Center of Excellence designation for just one surgeon.

Hi Pat and thanks.
I had it done at Morristown Memorial in NJ. Morristown is not one of them. And my surgeons office doesn't include fills with their surgery price. I have Medicare and Medicare won't pay for any aftercare unless you have it done at a hospital they approve of, and there is only 3 in my state, one way down in South Jersey, one way up north of me and only one other doctor about 40 min away.

Now here is the kicker, the one 40 minutes away was the first surgeon I consulted with, and I decided to go with someone else.

He will remember me and it would be awkward to say the least. "Hi, remember me? I didn't think you good enough to do my surgery, but can you give me fills?"

I'm just freaking amazed that Medicare would leave people like me out in the cold without after care.

Randi · July 6, 2006

Dody,[/url]

Being named as a Center of Excellence helps insurance members and patients identify and select Bariatric Surgery programs that provide comprehensive evaluation and care, superior clinical results, long-term follow-up regimens, demonstrated commitment and ongoing collaboration with participating hospitals. This designation takes into account extensive background information, including patient complication rates, combined with a one-day site visit to the medical center by a team of clinical experts.

Source: http://www.northeastmedical.org/press_releases/bariatriccoe.html

I traveled to Tennessee for my surgery because they won't even do surgery unless it is a center of excellence. I am lucky I have family here and they encouraged me to come here. I didn't want the surgery in the state I was from anyway. The dr's. there had only done about 50 lap bands between them. I was happy Medicare was recommending a center of excellence to be honest. A center of excellence means the dr. has done many, many lapbands. It basically has nothing to do with the hospital itself, but with the dr. My dr. here in Nashville has done over 1000 lapbands and therefore qualifies as a center of excellence. All my fills for 6 mo. are included.

Leener, can you run a google check and find a center of excellence not too far from you to get your fills at.

I've been working on my banding for about a yr. when Medicare threw this clunker into the works, but I have to admit at 64 I'm rather glad they did. I planned on coming to Tennessee anyway but to a dr. closer to Knoxville (Marysville) and he hasen't yet been accepted as a center of excellence and probably won't be, because he hasen't done over 1000 bands.I have found numerous things that were wrong with me that needed corrected before surgery that I believe I wouldn't have found anywhere else.

I traveled a long way to get this surgery and am staying for the fills, which are included for a 6 mo. period. I wish you luck in finding a center of excellence near by.

God Bless,

Dody

warmmorningsun · July 6, 2006

Leenerbumps, is it an option to contact the MD 40 minutes away with hat in hand and tell him what has happened and ask him to consider your situation and agree to do your fills? Not pleasant, but maybe necessary...?

NeenBand · July 6, 2006

Hi Aimee, I just might have to do that.

I like my current surgeon. This stinks.

Randi, I am headed there now with my comments. This surgery requires after care, it's amazing they would pull the availablity of doctors and hospitals out from under people.

I HEREBY DUBB THIS NEW CENTER OF EXCELLENCE THINGIE THE

"Medicare Stamp of Poop"

NeenBand · July 6, 2006

AN update for you, I called someone else at the office and they told me the "Medicare Stamp of Poop" will take a few months. So it would be worth waiting out to stay with my preferred doctors.

Randi · July 6, 2006

That helps your current surgeon not lose his patients to another facility, but how does that help you?

AN update for you, I called someone else at the office and they told me the "Medicare Stamp of Poop" will take a few months. So it would be worth waiting out to stay with my preferred doctors.

NeenBand · July 6, 2006

That's true. And I can't wait months for a fill. I'll have to call another doctor I found for the fill. I wish my doctor would take a reduced fee.

Randi · July 7, 2006

How many Bariatric surgeons does the Center of Excellence facility in your area support? Maybe you can obtain a list of names from that hospital and contact one of those docs for a fill. I'm sure your surgeon will understand. It's unlikelly that he didn't know this change was coming months in advance. It's more likely that the practice took a look at how many Medicare patients they had with lapbands may be affected and decided it was an acceptable loss in revenue should the Medicare policy go into effect.