smileykid

Medicare coverage

10 posts in this topic

Does anyone know if medicare covers WLS?  Or any of the skin removal afterward?  What about the supplemental policies/

THanks

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I only know that medicare does not cover any cosmetic surgery and skin removal is considered cosmetic.

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Medicare does cover WLS...including the sleeve. I am having the sleeve at the end of March, and Medicare is paying for it. You have to meet certain criteria:  Have a BMI greater than 35 and at least one related illness (sleep apnea, diabetes, high blood pressure) If your BMI is 40 or above, you automatically qualify without any of the illnesses mentioned. Medicare also doesn't require a 6-month weight loss plan like other insurance plans. Hope this helps!

Nina_1981, OliverBird and Offbeat like this

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I also have Medicare & Medicaid due to being disabled at age 52 three years ago. I am not able to exercise as much as I used to and my condition causes me to get sudden onsets of vertigo. These episodes cause me to fall quite often, resulting in broken bones, dislocated shoulder, twisted knees and ankles and numerous bumps on the head. Wouldn't it make sense that if I weighed less, I'd be more safe? I have only gone to an informational seminar and they are going to check my insurance to see if I'm covered for the bypass surgery.

I guess I'm worried and concerned about the different stories I read about Medicare's requirements. I have a BMI of 39.9, hypertension and high cholesterol, and other problems besides comorbidities. But I've never been on a medically supervised weight loss plan. But my weight has gone up steadily over the last 5 years or so. Will Medicare reject me because of not having been in a "program"? I'm just so ready to have this done and I'm antsy waiting to hear from my new doctor. I will be crushed if I'm denied coverage now that I've made this life changing decision.

Any help, suggestions or support?

Thank you!!!

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Medicare does cover WLS, Next time you get weighed, wear your shoes and hold your purse. Honestly, youbhave serious co-morbidities and WLS will change your prognosis.

tmcgee likes this

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Medicare does cover WLS, Next time you get weighed, wear your shoes and hold your purse. Honestly, youbhave serious co-morbidities and WLS will change your prognosis.

Hey Karen, good to see you.  You look great.  

tmcgee likes this

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On May 17, 2015 at 10:38 PM, OliverBird said:

I also have Medicare & Medicaid due to being disabled at age 52 three years ago. I am not able to exercise as much as I used to and my condition causes me to get sudden onsets of vertigo. These episodes cause me to fall quite often, resulting in broken bones, dislocated shoulder, twisted knees and ankles and numerous bumps on the head. Wouldn't it make sense that if I weighed less, I'd be more safe? I have only gone to an informational seminar and they are going to check my insurance to see if I'm covered for the bypass surgery.

I guess I'm worried and concerned about the different stories I read about Medicare's requirements. I have a BMI of 39.9, hypertension and high cholesterol, and other problems besides comorbidities. But I've never been on a medically supervised weight loss plan. But my weight has gone up steadily over the last 5 years or so. Will Medicare reject me because of not having been in a "program"? I'm just so ready to have this done and I'm antsy waiting to hear from my new doctor. I will be crushed if I'm denied coverage now that I've made this life changing decision.

Any help, suggestions or support?

Thank you!!!

I have a Medicare managed insurance plan. They ask about the last 5 years diet history. I had not been on a plan, so to speak, but I had somewhat of a physician assisted diet when I was first diagnosed with diabetes. I don't think they looked into it very thoroughly, and I didn't have to provide any proof. That wasn't an issue as far as my approval went. It's probably the same for straight Medicare, but if you don't have a supplemental plan, you may be responsible for 20% of the total bill

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Trish1967 how long did it take for the approval for Medicare ?

 

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14 hours ago, tracyringo said:

Trish1967 how long did it take for the approval for Medicare ?

 

Not Trish, but I am on Medi-Cal which is California's medicare program. 

It took 8 months of classes, diet documentation, visits to a shrink, for them to approve me for surgery. The actual approval took less than a day once my ducks were in a row. Like, I finished my last class, and 3 days later I was scheduled for surgery. It was just getting my ducks in a row that took a while. I paid nothing out of pocket. 

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