Hello,

Just discovered this forum. I'm an old member on Cruise Critic and Trip Advisor as well as photographic forums.

I'd appreciate your input on the following demographic info. How much of an uphill battle will this be?

Preferred Procedure: Gastric Sleeve followed by Banding

Medicare Covered procedure: Bypass and Lap-Band

Would like completed before Thanksgiving

Age: 68

Weight +120

BMI 46.4

Insurance: Medicare and UHC Medigap

Currently working in IT leadership

Gall Bladder (in a jar)

Long documented past history of Medical and other interventions for weight issues.

General Health: will be perfect if I drop the weight. Co-morbidity of hypertension.

My prior MD was rather small minded. He would not approve me for surgery the first time I asked. He said I couldn't follow through based on my history. Of course, his clinic booted all Medicare patients that would not use recommended advantage plans. My new Doctor is much more outcome oriented.

Thank You

Mike

What in the world do you mean by:

"Gastric sleeve followed by banding"?

I've never, ever heard of that.

That is the order of which surgery he would prefer having as I read it.

That is the order of which surgery he would prefer having as I read it.

Perfect! I apologize for the confusion. The sleeve rates #1 on my list followed by banding as #2. Medicare only authorizes (in CO anyway) Banding or Gastric Bypass.

(additional item)

Also, as much as I respect Dr. Alverez's work. Mexico is out of the question as any side effects would not be covered.

Do you have a surgeon in CO? I'm not sure what you're asking? Are you asking if Medicare will cover you with your weight and co-morbidities? The answer is yes I do think you'll be covered if this is your question

I am 66, was approved by Medicare for Gastric Sleeve. Yes, Medicare does pay for the sleeve. The only co-pay you may have is a small hospital co-pay, which your other insurance may cover. I am 5'3 and weigh 255. Wasn't overweight till Lexapro. But that is a story for another day. At this point in our lives, I guess Medicare figures it is less expensive for WLS than a quadruple bypass. My prior MD was small minded too. Told me I had to lose weight on my own. I am very hypothyroid and have tried. I also have BP problems. Couldn't leave this doctor's practice fast enough. Have an excellent primary care MD who has OKd the sleeve. At this point in our lives, are they really going to say no? When you mention gastric bypass, there is a more invasive procedure called the Roux-en-Y, the sleeve is less invasive. Best of luck in finding the best bariatric surgeon in your area. Again, as long as you are using Medicaire and not Humana or any type of H.M.O, you should be fine.

Edited August 11, 201412 yr by lene716

I weighed in at a BMI of 39.9 on my first surgeon visit. So badda boom.

However, all the other CoE hoops I had to jump through (all successfully) were just backed up horribly there -- lots and lots of patient applicants. It's taken months and months and months.

So getting through by November depends on your surgeon's patient pipeline.

Good luck.

I appreciate all of the wonderful input. It sounds like it's going to be an uphill climb just to get into the operating room.

There are some very well thought of Bariatric surgeons in Denver. You can't go wrong with any of these surgeons. They are all excellent.

Dr. Doru Georgescu, http://www.denverobesitysurgery.com/doru-i-e-georgescu.html (removed my gall bladder)

Dr Frank Chea http://www.skyridgemedcenter.com/conditions_we_treat/bariatric_surgery/meet-our-medical-director.htm (in my network)

Dr Tom Brown http://coloradobariatric.com/staff/thomas-r-brown-md/

Take Care & Thanks Again.

Mike

Whatever surgery you choose, there are hoops and hoops -- but oh my goodness, so worth it! I was happy before but I'm just so...happy! Good luck to you. Know that you are worth it. Worth it all! And it will go by before you know it.

Medicare does pay for the sleeve and the bypass. You have to jump thru all the hoops like regular insurance. I didn't use my Medicare on my surgery, I just used my husband's insurance. His insurance didn't require a six month diet or a psych evaluation. All I needed was to be over 18, bmi of 40, and bariatric center of excellence. Medicare requires all that stuff.

Medicare does pay for the sleeve and the bypass. You have to jump thru all the hoops like regular insurance. I didn't use my Medicare on my surgery, I just used my husband's insurance. His insurance didn't require a six month diet or a psych evaluation. All I needed was to be over 18, bmi of 40, and bariatric center of excellence. Medicare requires all that stuff.

Medicare has changed a LOT in the past couple of years. A person I know had the Lap Band in 2008 and had to jump through a lot of hoops. A documented 3 month pre-op diet, a lot of trying to get the surgery approved. So, with that mindset, I stated that this might happen before the end of the year. However, Medicare has changed a lot. I did not need a supervised 3 month diet. I had records of my weight for the past 3 years and, I have no idea why, but the bariatric surgeon's office stated this information they received precluded me from having to go on the 3 month supervised diet. I thought getting the surgery approved through Medicare would be a nightmare, but it wasn't. It seems, as I stated before, Medicare deems it more beneficial to pay for weight loss surgery than the complications from obesity. Like quadruple heart bypass surgery, or in nursing home stroke care. I am 66, went to the orientation for the surgeon I chose in July. I did, myself jump through hoops getting all the needed paperwork to the surgeon's office. One has to do a lot of this pre-op paperwork on their own. So for 2 weeks I sat on the phone asking that my medical records be faxed to the bariatric surgeon's office, I did go to my doctor to get a letter of medical necessity. I did have a psych eval done which lasted all of ten minutes, and this coming week I need to get an upper endoscopy done. Actually, the one hospital in my area..the Clearwater/St. Pete area has one hospital that has is a Center of Excellence. And they are booked by so many bariatric surgeons because of this reason. Medicare also doesn't require this either. Therefore I am going to another hospital closer by. The pre surgery diet starts around August 26th, and the surgery is scheduled for Sept. 9.

Edited August 13, 201412 yr by lene716

Medicare does pay for the sleeve and the bypass. You have to jump thru all the hoops like regular insurance. I didn't use my Medicare on my surgery, I just used my husband's insurance. His insurance didn't require a six month diet or a psych evaluation. All I needed was to be over 18, bmi of 40, and bariatric center of excellence. Medicare requires all that stuff.

Thank you Jtickle,

There seems to be some kind of regional variation on the gastric sleeve. According to the folks at Exempla/St Joseph in Denver, Medicare only covers Banding and the bypass in this area. However, it never hurts to ask then to check again.

If the surgery costs a bit more, that will be OK.

Medicare has changed a LOT in the past couple of years. A person I know had the Lap Band in 2008 and had to jump through a lot of hoops. A documented 3 month pre-op diet, a lot of trying to get the surgery approved. So, with that mindset, I stated that this might happen before the end of the year. However, Medicare has changed a lot. I did not need a supervised 3 month diet. I had records of my weight for the past 3 years and, I have no idea why, but the bariatric surgeon's office stated this information they received precluded me from having to go on the 3 month supervised diet. I thought getting the surgery approved through Medicare would be a nightmare, but it wasn't. It seems, as I stated before, Medicare deems it more beneficial to pay for weight loss surgery than the complications from obesity. Like quadruple heart bypass surgery, or in nursing home stroke care. I am 66, went to the orientation for the surgeon I chose in July. I did, myself jump through hoops getting all the needed paperwork to the surgeon's office. One has to do a lot of this pre-op paperwork on their own. So for 2 weeks I sat on the phone asking that my medical records be faxed to the bariatric surgeon's office, I did go to my doctor to get a letter of medical necessity. I did have a psych eval done which lasted all of ten minutes, and this coming week I need to get an upper endoscopy done. Actually, the one hospital in my area..the Clearwater/St. Pete area has one hospital that has is a Center of Excellence. And they are booked by so many bariatric surgeons because of this reason. Medicare also doesn't require this either. Therefore I am going to another hospital closer by. The pre surgery diet starts around August 26th, and the surgery is scheduled for Sept. 9.

WOW!!! Thank You Lene716,

This sounds even more encouraging. I appreciate the update.

Mike

WOW!!! Thank You Lene716,

This sounds even more encouraging. I appreciate the update.

Mike

You are welcome. Best of luck.