RNY to DS revisions and medicare

[monam]

Hi everyone I am new to this board and asking for advice. I live in Louisiana and looking to get a revision to a DS from an RNY which I had in 2006. My starting weight was around 430 and I lost to approx 230 back up to 360-370. I have Medicare. My question is can anyone give me the approximate cost of this surgery when using Medicare. I have e-mailed and called a few would have liked Dr. Keshishian since I have family fairly close by in Cali but cant afford the program fee on top of travel and co-pay. Dr. Stewart in Txdoes not accept medicare for revisions. So I am thinking about Dr. Roslin, Dr. Greenbaum, Dr. Buchwald and Dr. Simper kind of leaning toward Dr. Simper because my MIL lives in Vegas and said she would drive up to see me. I would like to correspond with someone who been through it. Thanks.

Read more: weightlosssurgery.proboards.com/index.cgi?board=talk&action=display&thread=6352#ixzz2KefEj78a

[pktwatch]

I did not know that Medicare would even pay for WLS.......

[Paula]

Medicare does pay for WLS, but you have to meet certain criteria for bariatric surgery. They also limit the types of WLS you can have. Ive got Medicare and my RNY to DS revision was covered. Medicare's criteria is:

1) BMI of 35 or greater
2) You have to have at least one co-morbidity related to obesity
3) You have to have a previous history of unsuccessful medical treatment for obesity documented by medical records
4) You have to have surgery at a Medicare designated Center of Excellence

[lynnn]

Feb 12, 2013 1:38:19 GMT -5 Paula said:

Medicare does pay for WLS, but you have to meet certain criteria for bariatric surgery. They also limit the types of WLS you can have. Ive got Medicare and my RNY to DS revision was covered. Medicare's criteria is:

1) BMI of 35 or greater
2) You have to have at least one co-morbidity related to obesity
3) You have to have a previous history of unsuccessful medical treatment for obesity documented by medical records
4) You have to have surgery at a Medicare designated Center of Excellence[/quote


I have a similar question re: Medicare coverage. Where can I find out if my Kaiser Advantage will cover the surgery without too much problem re: a referral, and do they cover the program fees for Dr K?

Thanks for any info you can give.

[Deleted]

Okay, I have Medicare but was a virgin DS. At the time, only three options were available. That was the crap-band, the RNY, and the DS.

In July of 2012, they added coverage of the VSG.
www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=57&ncdver=4&bc=AAAAgAAAAAAAAA%3D%3D&

And yes, it does HAVE to be a COE.

[Paula]

Mar 8, 2013 15:08:07 GMT -5 lynnn said:

I have a similar question re: Medicare coverage. Where can I find out if my Kaiser Advantage will cover the surgery without too much problem re: a referral, and do they cover the program fees for Dr K?

Thanks for any info you can give.

Lynn,

I've got straight Medicare myself. I know though that the Advantage plans do have more criteria sometimes because they are administered through private companies. Your best bet is going to be to either speak with the insurance person at Dr. K's office or Kaiser directly to find out about the criteria for you. I'm not 100% sure on this, but it was my understanding that the program fee was not covered by insurance. I know it was not billable to Medicare for me when I spoke with Dr. K's office when I was looking for a surgeon to do my revision.