I just stumbled across this 60's Section, and think it's great. Thanks to whoever came up with the idea. It's been a while since I've been on the forum, but I hope to hang around a little more now that some of life's challenges and issues have been met and conquered. I was banded on Aug. 30, 2007, and will become Medicare eligible July 1st this year. Someone on one of these threads said that Medicare picks up the cost of fills. Is there anything I need to tell the doc when this time comes? I just had my first fill since surgery (7 1/2 months), and may have to have more in the future, so this may be important to know. Thanks for your help.
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I don't have an official answer to your question about medicare coverage for fills - also have read several posts re medicare coverage and it was my impression from those posts that they do. You might check with your doc's office. If he/she accepts medicare they would know about the fill question. Some docs do not accept medicare at all. I am surprised to see that you have not had a fill since your surgery last summer. Have you been losing weight? I am waiting for paperwork to clear for my banding. Also a medicare patient and I have had some trouble finding a doc who accepts medicare assignment, patients over 65, AND is not backlogged for 2 years. Let's face it - when you are a medicare patient, the whole idea is to alleviate and prevent those serious health problems in the next 2 years! Kinda defeats the purpose if you have to wait... I finally found the place for me, and I'm very happy with it. They tell me it will be June or July. My application is date-stamped and on their desk!
Welcome lapbandaid, Always nice to meet another new "loser".
Medicare does pay for my fills. The clinic I go to offers a package deal that includes a year of fills and monthly followup visits. I'm not sure how they would do it in your case where you had the surgery before you were on medicare.
Tell us more about yourself.
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surgery 10/26/07
JoannMarie, I did talk to the doc a little this last time, but not about billing the fill....or is it filling the bill? I thought I was lucky to have Medicare, Blue Cross and Tricare (Military), but he told me (from his point and mine) that it doesn't make much difference. Medicare "allowable" (assignment) is all he can charge in our cases. The other insurances just pick up anything Medicare doesn't pay.....of the "allowable". He said that is why so many docs won't take Medicare. He also talked of formulas docs use to determine what %age of Medicare patients they can have and still make their "target" income. Amazing!!
That's probably the reason for 2 year backlogs. That sucks!! Sounds like you've finally got it squared away and will on your way soon. You asked if I have lost any without fills. See below>
Sfeiner, it's good to know that Medicare will pick up the tab for fills, as I have another 40-60 lbs. to go and am sure I'll be needing more in the future.
I've been on the overweight merry-go-round for at least 35 years. When in the Military I had to tow the mark, with some difficulty I might add. I've been retired for 18 years now, and inactivity, complacency, and apathy have really taken their toll. After getting all the "morbidly obese" medical problems.....high blood pressure, atrial fibrillation, diabetes, etc. Since I was spending more time at the docs. and pharmacies, I finally thought I had to do something to change this. I went to an info. seminar in late July 07, and right then and there signed up. I had to lose 30 lbs. before he would do the surgery, so I did that in one month. Had the surgery on Aug 30, 07. I wanted to to the whole loss program w/o fills, just in case I wanted to "pig out" from time to time, plus I've heard with fills people PB, slime, nausea and vomit. None of those sound very appealing to me, so no fills, no problems, right? I've lost a total of 80 lbs., but the last 3 months have only been 3-5 lbs. per month. This is why doc said it was time. I haven't noticed much difference, but I am being more aware (don't want the PB, etc.), and sticking to 1- 1 1/2 cups, 3-4 times a day. He filled 2 ml., and showed me on an unistalled band how much restriction it would do. Looked like about 8-10%. We'll see if it works.
Thanks for both of your inputs. It is appreciated.
From my research I know medicare only pays a fraction (small fraction) of what the docs charge. I can't blame them for taking a limited number of medicare patients/month in order to maintain their facilities, staffing, equipment, etc. It's all expensive! The one location I found with the long waiting list had been taking names while awaiting their approval as a Center of Excellence. It took a long time and now they have a very long waiting list. Medicare has been covering this surgery for just a little over a year, and lots of facilities have applied to become the Center of Excellence medicare requires them to be. It's a long process and things will probably loosen up in time. I am happy to find the facility I have found - even though I have to drive about 180 miles round-trip. Even with the cost of travel I will come out ahead because I can hopefully get it done early this summer. My application is in, my psych evaluation is set up for early May, and I have met the other requirements of medicare. I'm told my number should come up early June and I'll have my consultation and set a date for surgery which should be a few weeks following that consultation. So far, so good. I have done a lot of research and know this is the tool I can work with. Just wish I could have it done yesterday!
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