Getting started with Medicare Insurance

[AllieBB 7]

Hello ! This is my first posting. I am 66 yrs old. Same old, same old story off weight and diet yo-yo history for as long as I can remember. I am just beginning my journey with lap band surgery.

Here is my history: My top weight ws 412. I am currently 256 on 5/20 at the orthopededic surgeons office. For the past 12-18 months I have battled with the same 5 lbs and no weight loss. I NEED TOTAL KNEE REPLACEMENTS IN BOTH KNEES ! ASAP !!! My food program for the past four years has been a rigid glycemic index diet to ward off diabetes 2. That dietary switch changed my life's eating probably forever and took away 156 pounds. Once I was stuck on this plateau with knees that couldn't get exercise and do only limited walking I became more and more frustrated. At 412 my BMI was over 60. Now it is 47. My surgeon in New Zealand where I retired with my husband told me they will not do the surgery until my BMI was below 40. I was given access to the SWIM program in Januray. I decided to return home to the USA and consult with an orthopedic surgeon. Setting a new goal of the USA I staid off the scale and went swimming 5 days a week, two to three hours a day, worked with the aqua-orthopedic therapist every Wednesday and waited for the answers and progress report on 5/20. The result: My muscles got stronger. I got total relief of weight bearing pain in the Water. I started unable to swim even on lap because of the knee problem and three months later was swimming 15 laps and 1-1/2 hrs of aqua therapy and I was so hopeful. BUT NO, NONE, NADA change in my weight or BMI. And the surgeon explained that with a BMI of 30 I would have 5% chance of complications with healing after surgery and with a BMI of 40 there would be a 70% chance of complications with healing after surgery successful use of the prosthetic knee. Because of the stagnation/plateau for over a year even with the exercise in the pool he recommended bariatric surgery. So here I am.

On June 4th I have my pre-doctors visit seminar and scheduling of my doctor's appointment. I am excited and nervous at the same time. It is difficult to decide which feeling is which at this point. I am home for 5 more months before returning to NZ for a bit. Retirement is wonderful with spring/summer in the different hemispheres. All my ducks are in a row with what is needed for insurance/medicare but I am wondering how long the approval process takes. I would like to be able to schedule my surgery hopefully for July. Does anyone know how long the approval process takes?

I would like to join a support group with others in my age group to travel this journey. Any suggestions as to chats, forums, etc.?

[Bandarella 223]

I got Lapband because my insurance only covered that or RNY. I also planned to have left knee replacement. Unfortunately that never happened since my band was placed too high and caused me to lose over a year in Dx the problem and get it removed. My BMI was down to 35, was. 49 preop and is now 41 due to regain. Honestly, with all the long term complications of gastric banding and the expected EWL of. 40-60 % I would opt for gastric sleeve surgery. Better results, less long term complications and follow up care. Best of luck and congrats on losing 156 lb on your own!!

[AllieBB 7]

Bandarella, Thank you for your reply. Posting is new to me and it isnice to know that there are people out there reading and helping others to travel this journey. I am hoping that the getting to surgery process will be expedient. I have my initial seminar and post seminar doctor appointment scheduling on June 4. I would like to have the surgery in the beginning of July. I have read mays about liquid diets for weeks to months in length before surgery was scheduled. I don't even want to think about that being a possibility. I understand the two week for liver cleansing before surgery but the gastroenterologist tells me my liver is fine and not fatty. It is just a wait and see time I guess. Maybe I will post about that liquid diet and see wht other peoples experience has been. Thanks again for your reply and best words and thoughts for your encouragement and success.

[Bandarella 223]

The preop diet was the easiest part. I had 3 Meal Replacement shakes made with nf milk and dinner of lean meat 3-6 oz + all the low glycemic veggies I wanted at dinner and throughout the day. I lost a pound per day over the two weeks. The purpose of the preop low carb diet is to reduce glycogen on the surface of the liver. Glycogen is slippery and it makes the liver difficult to hold up and out of the way during surgery.

[marfar7 1,528]

Medicare doesn't have a pre approval process. If u meet the qualifications (bmi of >40 with no comoribities or >35 with 1) u just take ur chances and u find out after the surgery whether they paid it or not. At least thats what my dr office insurance coordinator told me.

Medicare paid for my lapband in 2009 and my sleeve revision 10 mths ago (at bmi of 28. I had a band complication that necessitated removal). Not sure what/if ur other insuance is, I'm just speaking for Medicare.

Good luck! Enjoy ur vvacation

[AllieBB 7]

Marfar7, Very helpful thank you. Did medicare also pay for fills etc? I am considering getting AARP supplemental in case I need additional coverage. Was it 100% or 80% covered?

Congrats on your progress and overcoming obstacles! Rncouraging!

[tebowfan 70]

Medicare doesn't have a pre approval process. If u meet the qualifications (bmi of >40 with no comoribities or >35 with 1) u just take ur chances and u find out after the surgery whether they paid it or not. At least thats what my dr office insurance coordinator told me.

Medicare paid for my lapband in 2009 and my sleeve revision 10 mths ago (at bmi of 28. I had a band complication that necessitated removal). Not sure what/if ur other insuance is, I'm just speaking for Medicare.

Good luck! Enjoy ur vvacation

Hi there, just checking to see if you had your revision with medicare.? My mom is having a lot of issues with her band and i don't know if she should look into another doctor, cause her current wls doc says medicate will only cover one wls surgery per lifetime. I'm worried about her.

[Sharpie 3,306]

had my band at age 66, medicare and BC/BS paid 100%. I have had fills for the past 2 years and follow up appts as needed. no out of pocket. I haven't had any complications with my band but hopefully if I do I can have a revision or another surgery . I doubt I would get 80% of my stomach removed but depends on my state of health and mind at the time. I am enjoying a new lifestyle of mobility and good health. I am diabetes free, normal blood pressure and normal cholesterol levels in many years.