New Medicare Changes....

Lee4love1 · 02-14-2007, 08:04 PM

Has anyone heard about the new changes with Medicare and Medicaid on "Bariatric surgery"?
Well, I was approved as of Jan 21-07. Then about Feb-4th-07 a new memorandum comes down. All patients wanting the surgery, must present more than 5 current weights. So with this being said--(I have to wait 3 more months--unless I get my records) He or she must show at least 2 times of weight loss failure. Today I had to track down my doctor on the coast. (Gulfport, MS). I had to have them fax the St Francis Hospital Bariatric center. It's now from (2002-2005) and now (2005 to 2007) for my new Dr. We're talking of at least 6 times a year that I went to the Dr/ I'd go every 60 days--since I had a weight issue--I was even asked if I could obtain my VA file. That's me sitting at the VA part of the day--I am not even sure if I can sit there too long. I may have to show up at records and get a copy of my file too...(1989-present)
The US made a deep cut into the medicaid. So now they are monitoring closely if we "morbidly obese" folks really need the surgery.
It's like I woke up in January and I went from 175 to 270 over night. It's cool, I had my records faxed quickly within 24 hours. My hope is still to have my LAP-BAND® done in march.....:faint:

SJB · 02-19-2007, 11:40 PM

Be thankful that you have the Medicaid/Medicare option. As an emplyee of the state of MS, I am paying for health insurance that will not even entertain the idea of paying for WLS - they go as far as to have an exclusion clause.

I will be paying for my surgery, fills, everything myself. Hopefully it will all work out for you and they will approve your surgery. Good luck!
:)

Lee4love1 · 02-19-2007, 11:48 PM

Oh....don't misunderstand me...Since I left my Goverment Job--I have Medicare and Blue Cross and BLue Sheild....When this is a fact and you retired due an injury--Medicare is the Primary insurance that controls the total deal I pay close to $500 a month in insurance--but here is this $98 insurance trying to stop me. Oh--I went on just last week and got 5 years of my weights and measures. They wanted at least 3 weight loss failures. My old Drs and new ones got them 6 years of medical facts. My surgery is on. I see Dr Weaver-Mcgraff on 28-Feb. She will gve me a few dates that is good....I am ready for this 9 days to pass. I am looking forward with a possible March 3rd through the 15th date.....So since I overcame the red tape...I am A-OK now....Lee

SJB · 02-20-2007, 12:32 AM

So glad everything is working out for you --just makes it seem all the more like it was meant to be. I know our state has a good retirement plan, but their insurance plan really steams me. Seems unfair that they can raise their ugly head at you as well, given the circumstances. Where is Dr Weaver-Mcgraff located? I know you can't wait for your surgery date...I can hardly wait to see Dr. King in March for my first visit. Let us know how it goes!:)

Lee4love1 · 02-20-2007, 07:14 AM

Dr Weaver-McGraff is Located in Memphis, TN at the St Francis Hospital==at the Bariatric Center there. It's about 30 miles from me. So I have to cross over to the next state--but it's ok by me. I was told by the Program director--withing 2 weeks after I see her(the Dr)--I'll be scheduled for the surgery.. I am trying to prepare my mind now for the lifestyle change. I am still finding myself hungry on a few days too, but I have been eating lighter. Plus--the band will give me relief from that hunger pain--thank God. I will not say too much to those "So called Friends of Mine"--who all said it was a waste of time or they heard it's dangerous--I will just show them. It's hard to convince folks who don't know our struggle. I am in the mindset to lose the weight and achieve max results. they said 2 pounds was the Max--but as I have read numerous articles on the LAP-BAND® and have read sooo many results all over the net--there are people doing excellant and getting at 3 pounds a week and maintaining that for 9 or 10 months before theylevel off to a managble 1.5 to 2 a week. My goal--to have a reasonable amount loss by December. I know the "new Lee" is in there waiting to pop out...lol....I hope it's possible to have at least a 65 to 75 pounds loss in 9 months.....I will keep you informed....Peace

SJB · 02-23-2007, 07:08 PM

I know what you mean - I don't want to say much either - I just want folks to see the results. You're right, people just don't understand our struggle. Keep the great attitude - I think that is half the battle.
:clap2:

Lee4love1 · 02-23-2007, 07:35 PM

Hello SJB...I will be keeping the faith and getting out of the way of the old "Lee"...I sure hope my spirits will be lifted very soon...I hate waiting--but as I wait--I inch closer....Speaking of "inches"...I am looking forward to losing at least 10 inches off my waist line and at least 8" from my chest

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