Anyone been Medicare approved

skinnyinMT · 12-28-2007, 12:01 AM

<p>Hi, I am on Medicare and am curious how easy they are to get along with for approval. Are there quite a few hoops to jump through? And does anyone have any help and quick approval advice. <img src="http://www.LapBandTalk.com/images/smilies/help.gif" border="0" alt="" title="Help" smilieid="256" class="inlineimg" /> I live in MT but all federal should be the same, I think!</p>

Genea · 12-28-2007, 06:38 AM

I have Medicare approval, and yes it take a few thing to get it. I had to go to a presentation by the doctors office about the LAP-BAND^®. My primary care doctor had to write a letter of necessity. They also listed my problems and treatments for them. I was lucky because I had a documented weight loss program and a history at a gym. With this information my LAP-BAND^® Surgeon went to Medicare and they gave their approval. My surgeon required me to go to my cardiologist and get approval due to my high blood pressure.

Your best bet would be to call a LAP-BAND^® Surgeons office and see if they have a support group or meeting for new patients. The people in the offices can take you through the process quickly and a lot better and I can. My process went quickly be cause I had all of the documentation. My surgery date is 12/31 so I am counting down. :clap2:
Genea

skinnyinMT · 12-28-2007, 10:22 AM

Hi Gina,
Thanks for the response. I have already been to a seminar with a doctor in Bismarck, ND. Sounds like maybe the primary care doctor has to give the most detailed information, is that right? And then the LAP-BAND^® Surgeon takes over from there to get the approval.

I have border-line hypertension and a history of back surgeries with one possibly pending. Could maybe be avoided with weight loss. I also suffer from horrible heartburn, have hand, arm and leg numbing, and painful joints. Do I sound like a candidate to you (in your opinion!)

Good luck with your surgery!! I will add you to my prayers for success.

gmmc

Genea · 12-29-2007, 09:08 AM

gmmc
It sounds like you could be a candidate to me. You did not say what your BMI is.
Medicare has guidelines for the BMI with or without other illnesses. Your Primary care doctor has to say they feel you would benefit from the procedure and show a history.
I would talk to the LAP-BAND^® surgeons office. They deal with this every day and can tell you what needs to be done and when. Also they will tell you what needs to be in the PC letter.

hijabigirl1973 · 12-29-2007, 11:43 AM

I have Medicare as well but my dr's office doesn't have to preauthorize for Medicare as long as the BMI is 40+ or 35+ with at least 1 comorbidity. I do know that Medicare will only cover charges that are at a center of excellence. They are also beginning to cover fills as long as your dr's office knows what code to use. I don't know what the difference would be though really, I mean why someone would have to go through the approval process while others done? Does anyone have an idea?

skinnyinMT · 01-01-2008, 05:21 AM

What about the fills, does Medicare pay for them?

hijabigirl1973 · 01-01-2008, 09:50 AM

I asked my doc's office this question and yes Medicare's starting to pay for the fills. I believe the coordinator told me they would pay for fills starting 3 months out from surgery but they were still experimenting with billing codes to see if they could get them paid sooner than that.

skinnyinMT · 01-01-2008, 10:36 AM

Is this about when you need the first one? What is the average times you need them?

hijabigirl1973 · 01-01-2008, 04:16 PM

Well I think docs are different when it comes to when they will give you your first fill. I asked my doc and he said he starts them at 4 wks as long as everything is going ok. I've heard others at 6-8 wks so I'm not sure. I'm not banded yet so I'm just going by what the doc and his office has told me.