Anyone Have Medicare? - ThinnerTimes

Ronna G · 10-09-2005, 03:28 PM

Have any of you had Medicare pay for your WLS? I was denied by BCBS of IL as I didn't complete a 12 month supervised diet (or fail at one) and due to disability I have Medicare starting in November and it will become my primary insurance.

Was wondering what if any experience any of you had dealing with Medicare?

Thanks in advance for your replies.

Ronna

Rachel- · 10-09-2005, 06:47 PM

I don't think that Medicare covers WLS. I believe PacifiCare does though.

Ronna G · 10-09-2005, 10:47 PM

I know that Medicare does cover WLS. I just was wondering what experience anyone has had using them.

Thanks

Rachel- · 10-09-2005, 10:50 PM

I was reading somewhere about Medicare and Medicade(Medicaid?? i don't know how it's spelled.) And the article said that a lot of people have problems getting approved for wls. I'm not sure though.

I know the article said that one of the two didn't cover wls. I was thinking it was Medicare that didn't, but I don't remember.

Ronna G · 10-10-2005, 12:24 PM

Actually they both cover WLS.

LizardQueen · 10-10-2005, 01:05 PM

I was just told the other day that BCBS of IL is a tough one to get to approve anything (a doctor told me this). Call Medicare and see what their requirements are. My Ins had several requirements that had to be completed before I saw a surgeon. I had to have a referal from my PCP and the psych eval done prior to seeing the surgeon. The only info they needed from the surgeon was a code number to complete the claim. That would probably be the best place to start. Where are you at in IL? I'm down south here.

lealphachienne · 10-10-2005, 02:49 PM

IL is a tough state to get anything medical done in.

Jennifer Miller · 10-10-2005, 06:06 PM

i got my referral from my primary for the 18th of Oct.
Dr. Potts stated in his introduction that when you have the first referral you usaually get the ok after you jump though the hoops.
Jenni

JimJ · 10-10-2005, 06:51 PM

Both Medicare and Medicaid pay for the surgery. the difference is that medicaid can be pre approved. If a person liek myself has medicare as his/her primary, they can still get teh surgery. the only thing that you need to knwo is that they may reject the claim. it has been known of them to reject it after several appeals.

If you do a search for medicare there are many threads relating to it. There are also a few that list the criteria for getting it approved. They are very stubborn when it comes to paying but it can be done.

HeatherT · 10-10-2005, 08:59 PM

Quote:

Originally Posted by Ronna G

Have any of you had Medicare pay for your WLS? I was denied by BCBS of IL as I didn't complete a 12 month supervised diet (or fail at one) and due to disability I have Medicare starting in November and it will become my primary insurance.

Was wondering what if any experience any of you had dealing with Medicare?

Thanks in advance for your replies.

Ronna

ok i have medicare - and i do not know what they did onthe Dr side but once i found a Doctor that took Medicare i was in and have had no problems - i saw that someone said the claim will be denied - is that after surgery? that scares me....

but as for me I have asked a few times when i am in the surgeons office and they said that medicare is covering everything - i have had no waiting really to complain about so i would say find a Dr near you that takes Medicare - my Dr is in Burlingame near S.F, they are on the web at www.ThinnerFuture.com ....I have to drive about 2 hours to go get my surgery...but i hope its worth it in the end

good luck -