Medicare where art thou

[nedsmehlp]

I tried contacting Medicare about the 6 month waiting period. Each person I talked to said I would have to call another number. I went through 3 different numbers and never found the right person to talk to. No wonder people get discouraged trying to talk to Medicare. I guess I'm just going to have to wait the 6 months!

Also, I would like to hear from all of you that have had a revision from VSG to DS. How slow was your weight loss, any complications, etc.

Thanks

 

[southernlady]

I tried contacting Medicare about the 6 month waiting period. Each person I talked to said I would have to call another number. I went through 3 different numbers and never found the right person to talk to. No wonder people get discouraged trying to talk to Medicare. I guess I'm just going to have to wait the 6 months!

Also, I would like to hear from all of you that have had a revision from VSG to DS. How slow was your weight loss, any complications, etc.

Thanks

I have Medicare (as an Advantage program). There IS NO 6 month waiting period. THAT is your surgeon saying that.
https://asmbs.org/resources/preoperative-supervised-weight-loss-requirements

Medicare requires that patients have been unsuccessful with medical treatment for obesity, but similar to the NIH consensus recommendations, does not require successful weight loss or mandate a specified type of diet or length of time, relying on providers to detail such efforts.

ALL Medicare requires is previous unsuccessful attempts and THAT is up to your PCP or surgeon to decide.

 

[nedsmehlp]

I have Medicare (as an Advantage program). There IS NO 6 month waiting period. THAT is your surgeon saying that.
https://asmbs.org/resources/preoperative-supervised-weight-loss-requirements


ALL Medicare requires is previous unsuccessful attempts and THAT is up to your PCP or surgeon to decide.

 

[nedsmehlp]

Well, I've had thousands of unsuccessful attempts! I was told they had to be consecutive. I'm going to call my surgeons office and talk with them. I want to get this surgery ASAP and start feeling better! Thank you for the information! I hope I can get somewhere with this information. It seems so ridiculous going to the Dietician and PCP every month, only to have gained a few pounds. My Dr and Dietician don't know anything about the DS or VSG. I am told to eat mostly veggies then protein. I hope I can get through these roadblocks!

 

[nedsmehlp]

Well, I've had thousands of unsuccessful attempts! I was told they had to be consecutive. I'm going to call my surgeons office and talk with them. I want to get this surgery ASAP and start feeling better! Thank you for the information! I hope I can get somewhere with this information. It seems so ridiculous going to the Dietician and PCP every month, only to have gained a few pounds. My Dr and Dietician don't know anything about the DS or VSG. I am told to eat mostly veggies then protein. I hope I can get through these roadblocks!

I talked to my surgeons office today. She said it just has to be 6 months and they don't have to be consecutive. My problem is that most of my diets have not been through my PCP. I was on Medifast, but ordered that through ebay. And my PCP prescribed Qsymia, but after a couple weeks of not working I just stopped taking and did not go back to my PCP the next month. And I was prescribed Belviq, but I never went back to my Dr the next month. Then I did Nutrisystem without going to my Dr. So there are no official records with my Dr.

 

[Larra]

This is the first time I've heard of the 6 months not needing to be consecutive. I would recommend you double check that for yourself. Actually, what I've seen over the years is insurers issuing denials if people saw their doc a day too late, or missed a visit, or if the doc failed to document in the medical records that the visit was for the 6 month diet, etc. This is the kind of thing where you have to dot the i's and cross the t's precisely.
of course the whole requirement is ridiculous and has nothing to do with your health or whether or not you will be successful with your surgery, it's just a barrier to prevent people from receiving an expensive operation and thus saving the insurer money, but that's another subject.

 

[southernlady]

I talked to my surgeons office today. She said it just has to be 6 months and they don't have to be consecutive. My problem is that most of my diets have not been through my PCP. I was on Medifast, but ordered that through ebay. And my PCP prescribed Qsymia, but after a couple weeks of not working I just stopped taking and did not go back to my PCP the next month. And I was prescribed Belviq, but I never went back to my Dr the next month. Then I did Nutrisystem without going to my Dr. So there are no official records with my Dr.

Mine didn't have official records either. But he knew I had tried everything before. So he signed off on it for me.

 

[nedsmehlp]

I was also told I did not have to see the dietician and my PCP. I only had to see one or the other each month, but not both. Is this true? I'm scared not to see both, just to make sure I have dotted all the i's!

 

[Larra]

Depends on your policy. Some will allow either a doc or dietician, some a doc only. I've seen people waste months seeing someone their insurer won't count. Check your policy for yourself.
I do like @southernlady's approach. If you have a pcp who knows you well, knows you've already tried a bizzilion times, and would be willing to sign off for you, go for it.

 

[southernlady]

I was also told I did not have to see the dietician and my PCP. I only had to see one or the other each month, but not both. Is this true? I'm scared not to see both, just to make sure I have dotted all the i's!

As I said. Medicare ONLY wants failed previous attempts. If you have dieted most of your life to no avail, then you have failed attempts. Get your PCP on board with that.

Now, the SURGEON may have the requirement but ask his office to prove IN writing where in Medicare it says the diet is required. http://bariatricfacts.org/threads/cms-center-for-medicare-medicaid-service-wls-standards.317/ There is a Decision Memo from Medicare in that post.

 

[nedsmehlp]

Thanks so much for all the information. I'm going to talk to my PCP at the end of the month when I go to her again. I'll also call and talk to my Plan F and see what stipulations they have in order for them to pay their copay for the DS.