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Medicare requirments



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Has anyone used Medicare for WLS? If so, what were the requirements? I have Medicare with BCBS Federal as a secondary. I was told I need to take a 3mth medicare weightloss class through my surgeons office. Is anyone else familar with this class?

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WHERE DO YOU LIVE? DOESN'T TAKE THAT LONG, I'M IN FL AND ONLY HAVE MEDICARE A&B , LORD HELP ME WHEN I GET MY 3 DAYS STAY AT HOSPITAL AND DOCTOR BILLS NOT ENTIRELY XOVERED BY MEDICARE ....all you really need is primary care doc to recommend you for surgery, blood test , a BMI of 30 or more with diabetes, high blood pressure or sleep apnea ,psychologist clearance chest xray ,pylori breath test ,nutritionist clearance and you should be ready to go ..hope it was helpful , Medicare has the info online or google Medicare requirements for wls or gastric bypass there are a few sites with good accurate information ,good luck, hope it helps

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I just made appointment with Gastric dr and he got it approved in just a day and I had to do the same as the other post above but I think that's standard for everyone

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I had to do a 3 month with nutritionist, get clearance from primary doc, cardiologist, cardiac stress test, an ultrasound of gallbladder, psych evaluation, 5 yrs of weight documentation, go to 2 weight loss support groups before submitting to ins. - Monday we submit to ins. Co. I'm so excited!! Hope its a quick response. Crossing fingers.

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I had to do a 3 month with nutritionist' date=' get clearance from primary doc, cardiologist, cardiac stress test, an ultrasound of gallbladder, psych evaluation, 5 yrs of weight documentation, go to 2 weight loss support groups before submitting to ins. - Monday we submit to ins. Co. I'm so excited!! Hope its a quick response. Crossing fingers.[/quote']

With Medicare ? What was your BMI and health conditions? Mine was 54 and sleep apnea and I got approved as soon as I asked my doctor....good luck

living4myself_gb1-21-13:

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I'm in RI, So its a Medicare / United Health Care/Rite Care. My starting weight is 258 a BMI of 46. I had a left kidney removal in 2010. We are submitting to ins. Co on Monday after my last 3'rd Nutrition appt.

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WHERE DO YOU LIVE? DOESN'T TAKE THAT LONG, I'M IN FL AND ONLY HAVE MEDICARE A&B , LORD HELP ME WHEN I GET MY 3 DAYS STAY AT HOSPITAL AND DOCTOR BILLS NOT ENTIRELY XOVERED BY MEDICARE ....all you really need is primary care doc to recommend you for surgery, blood test , a BMI of 30 or more with diabetes, high blood pressure or sleep apnea ,psychologist clearance chest xray ,pylori breath test ,nutritionist clearance and you should be ready to go ..hope it was helpful , Medicare has the info online or google Medicare requirements for wls or gastric bypass there are a few sites with good accurate information ,good luck, hope it helps

Have you had yours done yet? I have medicare a&b and Medicaid I am hoping they pick up the rest of my 20% and my deductible for my hospital stay that is 1216 dollars. What did you end up paying and did you have to pay before the surgery I am so stressed I see my surgeon on the 30th but I am trying to find out as much as I can to try to ease my mind.

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Medicare varies from state to state. For instance, I'm in California. Here Medicare does not pay for a Sleeve Gastrectomy but pays for RNY/Gastric Bypass. On the other hand, the requirements are "easier" to the point where if you meet the requirements of the Center for Excellence, you are there.

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Medicare varies from state to state. For instance, I'm in California. Here Medicare does not pay for a Sleeve Gastrectomy but pays for RNY/Gastric Bypass. On the other hand, the requirements are "easier" to the point where if you meet the requirements of the Center for Excellence, you are there.

Medicare is a federal program and does not very from state to state

Medicaid is a program run by individual states and the rules very widely from state to state

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    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
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    • Doughgurl

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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