Hello!

[DCA12V]

Hello! I've been reading about various weight-loss surgeries over several years and I'm absolutely certain that I want to have a DS, and that it would be an appropriate choice.

I decided to join this forum because everyone here seems nice / legit; it seems like it would be really fun and I could learn a lot.

Thanks!

 

[JuliaDS]

Welcome @DCA12V. You'll find a wealth of high quality information and genuine support here. Good luck with your journey!

 

[duh_Mom]

yep this it THE place @DCA12V glad you are here and have made the DS decision. There is lots of lots of good information here. Some you may not need till post op so use that bookmark feature to save it for later. Ask all the questions you need!

 

[Clematis]

Welcome! All your answers are here. Tell us more of your situation. What's your timeline? Insurance or self-pay?

 

[Pattycake813]

Omg in a week on this forum I have gotten more information than months of reading and meetings I attended prior to surgery. This is a great group of people who are living what you'll go through and getting their input is great

Welcome !

 

[aaa]

Hello.

 

[-Flo-]

Welcome! You found a great place.

 

[DCA12V]

Thanks for the welcome everyone! Sorry I made such a lame introduction post, I'm nervous talking to people, even online.

Welcome! All your answers are here. Tell us more of your situation. What's your timeline? Insurance or self-pay?

I thought I had a pretty good understanding of my timeline and insurance, but now after talking to a few surgeons offices I feel very confused.
I can't get a straight answer on how much money I need to save up.


I'm 30 years old, I weigh about 460 (59.1 BMI) I'm disabled and my "insurance" is Medicare with QMB which is supposed to pay whatever medicare does not pay...

If medicare "covers" the WLS but no one accepts "Qualified Medicare Beneficiaries" (I don't know why, they pay the copay on everything medicare covers with no questions..)

Does that mean I have to pay 20% of the surgeries "retail Price" ($25,000-$40,000) and then a medicare hospital copay of $1024 that is supposed to be covered by QMB, then a program fee of $3,000?

That can't be how it works can it? how could anyone consider this surgery "covered"?

Anyway, sorry about the wall of text, if I only had to pay travel + hotel I could probably get this done in about 4-6 months, but if I have to save around $8,000-$10,024 it might take me 20 months or more to save that up on disability. (I'll do it, it's just discouraging, and my health might get worse in that amount of time)

Has anyone here on medicare/QMB gotten a DS, if so does anyone know how much it actually costs out of pocket?
Are there DS surgeons that take "dual eligibles" and don't have an insane program fee?

Thanks!

 

[DSRIGGS]

Omg in a week on this forum I have gotten more information than months of reading and meetings I attended prior to surgery. This is a great group of people who are living what you'll go through and getting their input is great

Welcome !

Yep, you get the real poop here.

We actually live it unlike these nuts who teach about DS living by telling you to follow RnY rules. SMH.

 

[southernlady]

Welcome, @DCA12V

 

[hilary1617]

Hi and welcome @DCA12V ! I know little to nothing about medicare, but hope your procedure is funded sooner rather than later. I had to go through crazy hoops for insurance to cover my DS. It took a couple of years, but persistence ultimately paid off. The time in between proved to allow for useful preparation, frustrating though it was. Anyhow, wishing you all the best!

 

[Kate]

Greetings!

 

[Munchkin]

Welcome! Have you looked into applying for Medicaid too? That may give you some more options. I'm sure the insurance experts will be along to help you too!

 

[southernlady]

Straight Medicare is 80% with you footing the other 20%. I don't know (and I have been on Medicare since 2000) what QMB is for. Is it a state option?

However, if you are on Medicare (and I am talking the federal program not the state Medicaid programs), then you have the option in the fall (sometime in Oct to early Dec) to get a Medicare Advantage policy (preferably a PPO) that will cover the other 20%.

Below the age of 64 and above the age of (I think) 72, the Medicare Advantage is your best option if you need more than just doctor visit coverage. Between 64 and 72, the Medicare Supplement is your best option but soon than 64 and after 72, they are just way expensive for more than basic coverage.

If you are on Medicare, you should have received your Evidence of Coverage last fall after open enrollment closed. Changing Medicare options can only be done in the fall unless you move or are new to Medicare. Other life changing events that typically allow open enrollment for the ACA don't apply to Medicare since the policy is just for you and not based thru a spouse or thru a job.

 

[Larra]

You are actually almost certainly better off with Medicare than Medicaid. Medicaid is a state program, and pays doctors so poorly that most surgeons won't accept it. Also, some that do accept Medicaid will only accept their own state's version and not Medicaid from another state, or, even if they would accept it, the Medicaid program from State A won't pay for medical care in State B (even if the needed care isn't available in State A).
So even if you qualify, what you would get from Medicaid depends on what state you are in, and is probably not great.