To Old?

nedsmehlp

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Aug 10, 2016
Messages
171
Just talked to Dr. K's office. Medicare may not cover the DS at my age? I am so upset! They will check with Medicare, but they think they had trouble with Medicare not covering the DS on someone over 66. I will be devastated if they don't! Anyone know for sure? I don't think I can stand to wait to find out in a few days!
 
never heard that one before! That doesn't mean it couldn't be possible, but seems strange, esp when you consider that most people with Medicare are 65 or older.
Let us know what you find out. And I would recommend that you check for yourself as well as having them check for you. No one cares about this more than you.
 
Thanks Larra, I'll call Medicare and see what I can find out. If I hadn't been put off by Dr B I wouldn't have missed it by ONE MONTH!
 
Hmm, I don't believe that's true.

https://www.cms.gov/medicare-covera...of+Morbid+Obesity+(1st+Recon)&bc=BEAAAAAAEAgA

"Medicare beneficiaries age > 65
Bariatric surgeons who commented generally had a favorable opinion of the proposed decision. They basically recognized Flum’s work and agreed that there was an increased risk when performing bariatric surgery on patients over age 65. However, they were in general agreement that the benefits of surgery in reducing the co-morbidities outweighed the surgical risks. Many of the surgeons sent journal article references supporting their positions. We were able to utilize acceptable data from eight of the 30 articles referred to CMS by commenters (Appendix 4). A few surgeons related their experiences over an extended period of surgical practice.

Five comments were received from professional societies. Most commented on the growing problem of morbid obesity in the older population and wrote that CMS should reconsider covering bariatric surgery in the over 65 population.

Flum commented that his review demonstrated that surgeons with high volumes had outcomes as good or better in the 65 and older population as in the under-65 population.

Based on these comments and a re-evaluation of the data on surgical risk, we are revising our decision to provide coverage of identical procedures in the older population and younger population."

http://www.bariatric-surgery-source.com/medicare-bariatric-surgery.html

I hope it was some nincompoop in his office that said that - try again and let me know what the second answer is, and whether it came directly from him.
 
Thanks Diana, you are such a wealth of knowledge! I will talk to them today. From what I understand, they haven't worked with Medicare very often, so she just wanted to make sure before I got all ready to go and then might get disappointed with a denial from Medicare. I don't blame them for wanting to make sure. I am just frustrated with the first surgeon I went to, putting me off after all the hoops I went through!
 
Diana, I just went into that Medicare website you gave me and it sure looks like the DS is covered just like the other bariatric surgeries. I'm feeling a lot better! Will keep you informed.
 
@nedsmehlp Medicare covered my DS (I am on disability). Medicare does NOT preapprove and you will have to sign a paper saying if it's not covered, you are responsible BUT as long as you meet Medicare's standards for bariatric surgery, they will pay. You (and your surgeon) just have to have all the proper requirements met.
 
Question, @nedsmehlp? Standard Medicare, Med Sup plan, or a Med Advantage plan?
Reason I ask is that standard Medicare only covers 80% of the accepted cost. Example: if you had surgery and the accepted cost by Medicare is $1000.00, then Medicare would pay $800.00 and you would be responsible for $200. I believe bariatric surgery is 100% even with just Medicare BUT I am not positive.

Medicare also has an out of pocket copay for hospital procedures (in or out patient).

You need to look at the booklets (one would be called Medicare & You) that you received last time you enrolled. I got two this year, the Medicare & You, and the one from my Medicare Advantage plan.
 
Thank you Southernlady. I really appreciate all the info. I'm going to check into this further.
 
Since this is a surgery that will be done inpatient in a hospital setting, the most you should be out is your Medicare Part A deductible of 1316.00, provided you have not met this deductible in the past 3 months. Pretesting labs will not have a copay, but pretesting x-rays will. If you have a good secondary insurance, it should cover all copays and deductibles. Some hospitals require the deductible upfront. This does not include the physician charges--they are Part B and you will have copays and deductibles on those. The current deductible for Part B is 183.00.
 
Since this is a surgery that will be done inpatient in a hospital setting, the most you should be out is your Medicare Part A deductible of 1316.00, provided you have not met this deductible in the past 3 months. Pretesting labs will not have a copay, but pretesting x-rays will. If you have a good secondary insurance, it should cover all copays and deductibles. Some hospitals require the deductible upfront. This does not include the physician charges--they are Part B and you will have copays and deductibles on those. The current deductible for Part B is 183.00.
Now if you have a Medicare Advantage plan, your copays and deductibles may be different. Not all Medicare Advantage plans cover everything Medicare does.
 

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