I have been a doctor in the state of Utah for several years now, and if you have tried effortlessly to lose weight, and cant, you can get a doctor referral to a weight loss clinic. Now I do understand the concept of people thinking that weight loss is a cosmetic change, however if you are 80 pounds overweight with heart complications, diabetes, and asthma. Now I am not saying your Medicaid will accept you, I can not do that the decision is up to the Medicaid office. You can only upload files of type PNG, JPG, or JPEG. You can only upload files of type 3 GP, 3 GPP, MP 4, MOV, AVI, MPG, MPEG, or RM. You can only upload photos smaller than 5 MB. You can only upload videos smaller than 600 MB. You can only upload a photo (png, jpg, jpeg) or a video (3gp, 3gpp, mp4, mov, avi, mpg, mpeg, rm). You can only upload a photo or a video.
Will Medicaid Pay for Reconstructive Plastic Surgery after Weight Loss? Please seek a board-certified plastic surgeon who is experienced in breast reduction and lifts surgery after massive weight loss. In addition please seek a board-certified plastic surgeon who is willing to work with you and Medicaid. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. These procedures are typically not covered after massive weight loss. Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify.
UW Health Medical and Surgical Weight Management surgeons perform the Roux-en-Y gastric bypass, laparoscopic adjustable gastric band and sleeve gastrectomy procedures as well as revisional surgery for people who have had previous weight loss surgery. The following is basic insurance information regarding bariatric surgery. Please note that coverage varies widely, each employer may purchase a different plan and the information below may not apply to your individual plan. Please call your insurer or employer's benefits department for the most current and accurate information regarding coverage and requirements of your plan. We recommend that you call the customer service number on the back of your insurance card. Provide your ID number and ask if bariatric surgery is a covered benefit and what requirements for surgery are specified by your plan. Once you have started with our program, we will ask for a copy of your insurance card and will call to verify your benefits and confirm that our facility is in network under your plan. Will my insurance cover the costs associated with surgery? Depending on your insurance plan, the supervised diet may be done with your primary care provider or a registered dietitian; some structured programs (such as Weight Watchers or Jenny Craig) may also be acceptable. The UW Health Medical and Surgical Weight Management Program offers self-pay packages for gastric bypass (Roux-en-Y), sleeve gastrectomy and adjustable gastric band procedures. Please contact our program to discuss whether this may be an option for you and for pricing information. Medicaid/Badgercare offers the gastric bypass, sleeve gastrectomy and adjustable gastric band procedures to beneficiaries with a BMI greater than 40 with at least one severe medical condition (such as uncontrolled diabetes, hypertension, heart disease or obstructive sleep apnea).
Would you like to make it the primary and merge this question into it? • The surgery is medically necessary. Bariatric surgery is not a benefit when the primary purpose of the surgery is any of the following:• For weight loss for its own sake. Bariatric, or weight-loss, surgery began in the 1950s. Doctors have found that most people have great success with just the first part of the surgery performed, and so it is gaining in popularity. With the gastric sleeve surgery, the stomach is drastically reduced, to about 25 percent of its original size. Because food is digested in the stomach, this is not as severe with gastric sleeve surgery. In many people's minds, the main purpose for any bariatric surgery is to improve the chances of morbidity in the morbidly obese, and certainly this type of surgery achieves that. This is even more the case with anyone having bariatric surgery, because obesity is a risk factor in complications from surgery. Staying obese or having the surgery. Based in this excellent study and others, the evidence is very strong that the surgery is much safer than staying obese.
Health Insurance Will Cover Obesity Treatment in 2015. In an exciting new development, many Americans will soon have the option to switch to a health care plan that does cover obesity treatment—including bariatric surgery, weight loss programs and nutritional counseling—under the Affordable Care Act, commonly known as “Obama Care.” (See our table below for state-by-state details.) While not every state has agreed to incorporate obesity treatment into their marketplace health plans yet, this is a significant step in the right direction and we encourage you to review your options. All enrollment closes on February 15, 2015, after which you will no longer be able to sign up for a health plan in or out of the Health Insurance Marketplace for the rest of 2015. Consult the table below to see which obesity treatments your state includes. If you live in a state that does not offer coverage for weight loss treatment in the Health Insurance Marketplace, there may be private insurance providers in your area that do. Whether or not you can obtain a plan that covers weight loss treatment options, NOF can assist you in finding an accredited bariatric surgeon in your area that best suits your needs. Obesity Treatment Options Under the Affordable Care Act by State.
Does Medicaid pay for bariatric surgery? Does medicaid pay for bariatric surgery and if so which ones? In general, Medicaid programs cover bariatric surgeries for some patients under circumstances that are very close to the rules set up by Medicare for its coverage of these surgeries. To find out more details about the conditions under which Medicare covers bariatric surgeries, see Medicare's official National Coverage Determination (NCD) for bariatric surgery for Treatment of Morbid Obesity (100.1) . Given all these rules, obtaining Medicaid coverage of bariatric surgery requires the close cooperation of the doctor who is treating you for your obesity.
Medicaid is for many the sole source of health care coverage. Weight loss programs fall into the latter category, and each individual seeking coverage needs to know where to look for information. Medicaid and Weight Loss. However, individuals whose only access to medical care is through the Medicaid program might have difficulty finding information on weight loss or management programs through their coverage. Some aspects of the Medicaid program are uniform by federal law, but the states are allowed to determine their own policies with regard to Medicaid-covered weight loss programs. Families USA goes on to state, "Individual cases about Medicaid coverage of gastric bypass surgery generally involve proving that for a particular patient, the surgery is medically necessary and not cosmetic." If gastric bypass surgery is necessary for you, the best approach for obtaining coverage is to communicate with your doctor as you submit your claim to Medicaid. As you seek out coverage for weight loss programs and procedures through Medicaid, remember that each state administers its own plan. With just a little research and initiative, you should be able to quickly discover what resources are available to you for weight loss under Medicaid in your state.
What are the drug copayments for pharmacy claims paid by Indiana Medicaid? What are the days supply limits on maintenance and non-maintenance drugs? What are the guidelines for coverage of drugs for Indiana Medicaid? What is a Preferred Drug List (PDL), and how are drugs placed on the PDL? PDL is an acronym for preferred drug list, which is a portion of all drugs covered under pharmacy benefit. Drugs in classes that are subject to the PDL are designated as either preferred or non-preferred; preferred drugs typically do not require prior authorization, whereas non-preferred drugs generally do require prior authorization. Where is the Preferred Drug List (PDL) located? You can find the PDL by clicking on the Preferred Drug List link. What is the Preferred Drug List (PDL) status of mental health drugs? I cannot find certain drugs listed on the Preferred Drug List (PDL); what does this mean? Drugs that are not listed on the PDL are covered by the Indiana Medicaid Program, to the extent they are not specified by 405 IAC 5-24-3 as non-covered.
Lap band: Weight loss surgery. Free weight loss seminar. Sign up today for a FREE weight loss surgery class to learn more about obesity surgery options, including the lap band procedure, and talk one-on-one with our clinical staff and patients. Am I a candidate for lap band surgery? We can help you decide whether bariatric surgery is right for you and if you are a candidate for adjustable gastric band surgery. Register today for a FREE weight loss surgery class to learn more about obesity surgery options and talk one-on-one with our clinical staff and patients. We are one of the most experienced lap band surgery programs in Indiana with outstanding results. Lasting weight loss with lap band. In 2012, she attended a weight loss seminar with Dr. Mc Ewen and knew that lap band surgery was the right choice. Considering lap band surgery? Call or e-mail today to attend a free weight loss surgery workshop !
But when you have a lot of weight to lose, and if exercise and diet aren't enough, you might consider weight loss surgery , also called bariatric surgery . You'll probably have questions about how much it costs, what insurance covers, and how to convince your insurance to cover the bill. Weight Loss and Health Care Reform. Weight loss surgery is expensive. The price of your weight loss surgery will depend on several factors: This will vary based on where you live, your surgeon's expertise, and the procedure’s complexity. Costs will vary and may include the operating and hospital rooms, among other fees. If you don’t have health insurance, you’ll likely have to pay the entire bill yourself. Some weight loss surgery centers can help you get a loan that you can repay over a number of years.
How to get your health insurer to pay for your weight-loss surgery. Even with your doctor’s recommendation and coverage available from your health insurance policy, your health insurer might not pay for the surgery. If you’re considering bariatric surgery and want your health insurance to pay for it, you may have to jump through a few hoops. It's common to find health insurance companies that will not pay for weight-loss surgery, yet these same insurers are paying for years of treating the conditions associated with obesity. Your best chance for attaining insurance coverage for weight-loss surgery is through a group health plan. The American Society for Metabolic and Bariatric Surgery certifies "Centers of Excellence" around the country. For Aetna plans that do cover bariatric surgery, here is a summary of the criteria for gastric bypass approval: Bariatric surgery is specifically excluded under the standard CIGNA Health Care plan, but employers can elect to include or exclude coverage for bariatric surgery in their group health plans. CIGNA Health Care also covers medically necessary reversal for bariatric surgery when a patient has complications and, under certain circumstances, covers revision of a previous bariatric procedure when the patient has not lost adequate weight. At best, you'll need mounds of documentation to show the surgery is medically necessary for you. Hutcher compares submitting a claim for bariatric surgery to playing roulette: "And in roulette, you know the house always wins," he says. So why do health insurers seem to fail to see the cost-effectiveness in paying for surgery versus paying for years and years of treating related conditions? You will probably need to provide further documentation of your need for the surgery as medically necessary.
IU Health Bariatric & Medical Weight Loss has been named an American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Surgery Center of Excellence. Indiana University Health North Hospital was designated as a Blue Distinction Center by Anthem Blue Cross and Blue Shield in the area of bariatric surgery in 2012. All staff members are deeply committed to the science and art of caring for morbidly obese patients. Weight loss surgery is only one aspect of the IU Health Bariatric & Medical Weight Loss program. While surgery can help you achieve your initial goal of weight loss, the preparation and exceptional follow-up treatment is how IU Health sets itself apart. We partner with Indiana University Health Arnett Hospital and Indiana University Health Ball Memorial Hospital to provide a medically supervised weight loss program for those who do not qualify for or may not want the surgery. Operations that reduce the stomach size are known as restrictive surgery because they restrict the amount of food the stomach can hold. All of the weight loss surgeries at IU Health Bariatric & Medical Weight Loss are minimally invasive or "laparoscopic" surgeries, unless there is a medical reason that would not allow minimally invasive surgery. Roux-en-Y gastric bypass surgery is the most common and successful malabsorptive surgery. It is the primary surgery performed by IU Health Bariatric & Medical Weight Loss. Today, this procedure is considered the “Gold Standard” for bariatric surgery. The operation is typically completed in about one hour and most patients stay in the hospital for one or two nights. The intestines are not manipulated in this operation, so it is an ideal option for those patients who have previously had extensive intestinal surgery or have dense adhesions. The bariatric surgeons at IU Health Bariatric & Medical Weight Loss are highly skilled and experienced in bariatric surgery.
You are here: Home / Medicaid for Gastric Sleeve. Medicaid for Gastric Sleeve. At the moment, there are just a few states that allow Medicaid for Gastric Sleeve Surgery, many states do not allow Medicaid to cover obesity or the cost of the procedure. The Medicaid program is being run by each state, and as it stands, only a small number of state programs offer Medicaid for gastric sleeve surgery. From February of 2006, the gastric band weight loss surgery has been covered by Medicaid as a treatment for morbid obesity. Previously, Medicaid for gastric sleeve surgery was not commonplace. Only recently has Medicaid for gastric sleeve surgery become an issue due to the rising popularity of the procedure. Medicaid for Gastric Sleeve – Coverage Guidelines. Medicaid for gastric sleeve surgery is a possibility. Medicaid for Gastric Sleeve surgery to treat the underlying obesity is only covered on a very limited case source and the coverage for the said weight loss surgery may vary on a state by state basis. If you are looking at ways to make the sleeve gastrectomy procedure affordable, you should investige Medicaid for gastric sleeve surgery a bit further. There are limited surgeons who are willing to accept the Medicaid for gastric sleeve surgery as a payment.
What bariatric surgery procedures are covered? May I have a copy of the Medical Policy statement for bariatric surgery insurance coverage? What is the annual deductible, if any, and how much have I met so far? Here’s how: Let’s say you have already met $875 of your $1,000 annual deductible, and your insurance plan year begins (renews) on August 1. If you have surgery on August 2, you would again be responsible for the $1,000 deductible amount, instead of the remaining $125 from the previous year. Every year we see a heightened interest in bariatric surgery in November or December because people have met their deductible and want surgery before the new year when their insurance renews. People who are considering weight loss surgery and want to take advantage of the lower insurance deductible should start the process early enough to ensure that they can get surgery by the new calendar year. It is a way to make sure the procedure is covered under your Bariatric Surgery Insurance policy. What are some of the most common bariatric insurance coverage requirements? Some of the most common bariatric insurance coverage requirements include: What if my insurance provider denies the coverage? The surgeon’s office will be notified of the denial of coverage and will assist with you the appeal process if you choose to appeal.
As you consider if weight loss surgery is right for you, it is important to understand the financial aspects of the surgery. Call your insurance carrier to ask about your insurance benefits and if you have coverage for bariatric surgery. Your insurance company does not determine this type of coverage – your employer may provide weight loss treatment coverage. Know all the costs of your surgery, particularly if you choose to pay for the surgery yourself. Self-payment may be your best option if your insurance plan or employer does not offer coverage, or if you are not employed. Talk with our bariatric information specialist about how your insurance may cover costs of the surgery. Please understand that we can help you explore your treatment options. You must pursue approval for coverage by your insurance company. That's why it's important to ask questions, get answers in writing and work with your healthcare team to understand your treatment options that will help you achieve your weight loss goals. Weight loss surgery insurance approval. At Team: Bariatrics, we can help you understand your treatment options and what questions to ask of your insurance provider. That means you need to remain active in the process as we work together to get you on the path to achieving your weight loss goals. You must send a complete record of your health history to your insurance company. To learn more about insurance coverage of your bariatric surgery, call our bariatric information specialist at 877.457.5678.
Coverage of Obesity Treatment: A State-by-State Analysis of Medicaid and State Insurance Laws. We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers. Very few states ensure coverage of recommended treatments for adult and pediatric obesity through Medicaid or private insurance. In fact, in 2004, the Centers for Medicare and Medicaid Services (CMS) removed language from the Medicare Coverage Issues Manual stating obesity was not an illness. Few studies have evaluated public and private insurance coverage of primary obesity treatment, especially at the state level. We conducted a state-by-state analysis of (1) Medicaid and EPSDT program coverage and payment practices for adult and pediatric obesity assessment and treatment, (2) the extent to which states prohibit or regulate insurers' medical underwriting or eligibility exclusion of obesity, and (3) the extent to which state insurance laws address coverage of obesity treatment. In previous studies of insurance coverage for obesity treatment, researchers utilized surveys to collect data from private insurers and state Medicaid programs. 17 – 21 We selected the following interventions for analysis of Medicaid coverage and payment practices for adults with obesity: nutritional assessment/counseling, drug therapy, and bariatric surgery. We reviewed provider manuals for (1) provider guidance for the assessment and treatment of obesity, (2) coverage and reimbursement of specific obesity-related treatments, and (3) explicit exclusions of obesity-related assessment or treatment. We found evidence that 26 state Medicaid programs covered nutritional assessment and consultation for obesity. Medicaid coverage of childhood obesity assessment and treatment. We found that in 45 states and the District of Columbia, no legislation protects individuals from being denied health insurance based on obesity or health status. The majority of state codes are silent on the coverage of obesity treatment for both the group and individual insurance markets. Our findings suggest that most states are not ensuring recommended screening and treatment of adults and children for obesity through Medicaid, the EPSDT program, or private insurance. Prevalence of overweight and obesity in the United States, 1999–2004.
Are you sure you want to delete this answer? You can find approved facilities by searching on this website: http:/www.cms.hhs.gov/center/coverage.a. If you contact these facilities they will help your further. Also if your insurance denies you , which they might. You can and shouls appeal. Be tough,say they are discriminating against you . And if they do not reconsider you will continue and retain legal counsel. Make sure your Doctor is in complete agreement that you physically have to have this surgery. You can only upload files of type PNG, JPG, or JPEG. You can only upload files of type 3 GP, 3 GPP, MP 4, MOV, AVI, MPG, MPEG, or RM. You can only upload photos smaller than 5 MB. You can only upload videos smaller than 600 MB. You can only upload a photo (png, jpg, jpeg) or a video (3gp, 3gpp, mp4, mov, avi, mpg, mpeg, rm). You can only upload a photo or a video.
Would you like to make it the primary and merge this question into it? Will Georgia medicaid pay for gastric bypass surgery? Update to "Bariatric Surgery Benefits Now Available" This is an update to an article that was posted on this website on January 9, 2008, titled, "Bariatric Surgery Benefits N…ow Available." Effective for dates of service on or after July 1, 2008, bariatric surgery services will be benefits of Texas Medicaid (for clients 21 years of age and older) and the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) (for clients birth through 20 years of age). • The surgery is medically necessary. The documentation must contain a description of why the bariatric surgery is medically necessary in the context of current treatment and the medically reasonable alternatives that are available. Bariatric surgery is not a benefit when the primary purpose of the surgery is any of the following:• For weight loss for its own sake. Behavioral health services provided as part of the preoperative or postoperative phase of bariatric surgery are subject to behavioral health guidelines and are not considered part of the bariatric surgery. Reimbursement rates for bariatric surgery procedure codes will be assigned after the rate hearing scheduled to be held on June 1, 2008. Is Gastric Sleeve Surgery Right for You? Bariatric, or weight-loss, surgery began in the 1950s. Doctors have found that most people have great success with just the first part of the surgery performed, and so it is gaining in popularity. With the gastric sleeve surgery, the stomach is drastically reduced, to about 25 percent of its original size. Because food is digested in the stomach, this is not as severe with gastric sleeve surgery. In many people's minds, the main purpose for any bariatric surgery is to improve the chances of morbidity in the morbidly obese, and certainly this type of surgery achieves that. This is even more the case with anyone having bariatric surgery, because obesity is a risk factor in complications from surgery.
The patient still meets the medical necessity criteria for the bariatric surgery. The surgery must take place at a Center of Excellence. They will also need to have privileges to perform the weight loss surgery at the accredited Center of Excellence. You can also look on their website www.anthem.com for the email address and contact number.
Does Medicare & Medicaid Cover Weight Loss Surgery? Medicare & Medicaid. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). The Medicaid program is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). Medicare will cover weight loss surgery surgery for qualified patients when the procedure is performed by approved surgeons and facilities. Although Medicare pays for weight loss surgery, they do not pre-authorize so it is important to be certain of the requirements for surgery coverage.
As a result, many insurers now cover all or some of the costs associated with gastric sleeve surgery . Insurance coverage for gastric sleeve surgery varies by state and insurance provider. Gastric Sleeve Insurance Coverage: What Is Covered? Insurance coverage for gastric sleeve surgery tends to be similar in scope to coverage of other bariatric surgeries. Some insurers may pay the entire bill, but others only pay 80 percent of what is considered "usual and customary" for gastric sleeve surgery. If you are considering gastric sleeve surgery, contact your insurance plan to find out if the procedure is covered, and what such coverage entails. Gastric sleeve insurance coverage may include the program elements that are necessary to be successful with your procedure such as support groups, exercise and nutrition counseling. Some people may not lose enough weight with the gastric sleeve surgery alone and may need a secondary procedure such as duodenal switch or gastric bypass surgery . Insurance carriers cover the cost of gastric sleeve surgery if you meet certain pre-specified criteria, which vary by company. United Healthcare will cover the cost of gastric sleeve surgery for individuals with a BMI of 40 or higher, or a BMI 35 to 39.9 and one obesity-related illness. If a person has severe heart and lung problems associated with obesity, however, they may lower the BMI requirement and cover the costs of gastric sleeve surgery. Gastric Sleeve Insurance Coverage: Action Points. Gastric Sleeve Insurance Coverage: Other Options. If you choose to pay cash for gastric sleeve surgery, complications may not be covered. Some bariatric surgery centers may offer "reinsurance" plans that will cover the cost of complications during the first year after surgery if you pay cash for your gastric sleeve surgery.
We have the answers to all your pressing questions about weight loss surgery and insurance. In general, the costs of weight loss surgery comprise anesthesia, the hospital facility and the surgeon's fee. And the weight loss surgery is likely not the last surgery you will undergo. Who Foots the Bill for Weight Loss Surgery? Insurance coverage for weight loss surgery varies by state and insurance provider. If you are considering weight loss surgery, the first step is to contact your insurance plan to find out if the procedure is covered and what, if any, caveats may exist. Medicare and Weight Loss Surgery. Medicaid and Weight Loss Surgery. Private Insurance Companies and Weight Loss Surgery. Many private insurance companies will cover weight loss surgery if your primary care doctor informs them that the surgery is medically necessary. Your chosen surgeon can be a partner and a resource in your quest to get your insurance carrier to cover your weight loss surgery. Parting Thoughts on Weight Loss Surgery and Insurance. Remember that it makes good financial sense for your insurer to foot the bill for your weight loss surgery. What's more, the cost of drugs for people with diabetes and high blood pressure plummet following weight loss surgery.
Just like different insurance plans may have exclusions of coverage for weight loss-related programs and treatment, so do the insurance plans provided for by state Medicaid programs. The question “Will Medicaid Pay for Weight Loss Drugs” is answered in the August 2010 report Medicaid Fee For Service Treatment of Obesity Intervention (pdf). Although Medicaid is not required to cover weight loss medications, many states have opted to add coverage for patients fitting specific criteria. Twenty-seven states exclude any coverage of drugs commonly prescribed for weight-loss purposes. Some states provide coverage for lipase inhibitor drugs or amphetamines, but not specifically for the diagnosis of obesity. States which specify coverage of Xenical (Orlistat) include Minnesota, Missouri, and Nebraska. Eighteen states offer pharmaceutical coverage for weight-loss products provided that certain criteria are met. Within this group, states which limit coverage to Xenical (Orlistat) include Alabama, Florida, Georgia, Iowa, Louisiana, New Jersey, North Dakota, and South Carolina. States which cover all three lipase inhibitors (Xenical, Meridia, and Adipex) under Medicaid include Kansas, Rhode Island, South Datoka, and Vermont. Several states (Hawaii, Iowa, Louisiana, New Hampshire, New Jersey, South Carolina) specify that weight-loss drugs are only approved for persons who have a BMI ≥ 30, or BMI ≥ 27 if the patient has a co-morbidity such as hypertension, dyslipidemia, diabetes, sleep apnea, or coronary artery disease. North Dakota however requires that the patient start with a BMI ≥ 40 and lose at least 5% body weight in six months; once the patient’s BMI gets below 30, prescription coverage is terminated. Some states (Alabama, Iowa, Michigan, Vermont) require that the patient has tried physician-supervised diet regimen unsuccessfully for six months before receiving approval for weight-loss drugs. As you can see, the requirements for Medicaid coverage of weight-loss drugs vary greatly by state.
Bariatric Surgery & Medical Weight Loss. Weight Loss Surgery. Our weight loss (bariatric) surgery program at LGMC is distinctive. Nutrition, exercise, behavior modification counseling and support groups, are among the resources offered to insure your success after weight loss surgery. The bariatric surgery department at LGMC was accredited as a metabolic and bariatric surgery and quality improvement program. This is a joint program of the American College of Surgeons and American Society for Metabolic and Bariatric Surgery. Non-Surgical Weight Loss Program. Lafayette General Medical Center’s Bariatric Surgery program has developed a comprehensive weight loss program for people who want to lose weight, but for whom surgery is not a desire or option. D., oversees the program at Acadiana Weight Loss Surgery, located at Lafayette General Surgical Hospital. For more information about the Medically Supervised Weight Loss Program, call (337) 289-8484.
The documentation also must contain a description of why the bariatric surgery is medically necessary. The prior authorization request must include documentation to show that the patient has demonstrated his/her compliance with medical treatment. The patient also must have demonstrated at least 6 months of compliance with a physician directed, non-surgical weight-loss program that occurred with 12 months of the request date. That the patient is psychologically mature and can cope with the post-surgical changes. That the patient and the parent/guardian (as applicable) understand and will follow the required changes in eating habits. How the patient will accept post-operative surgical, nutritional, and psychological services.
The new coverage means that, for the first time, Medicare will pay doctors to discuss weight problems with patients, advise them on diet and exercise, monitor progress and provide encouragement in regular visits. As a first step, you can use an online BMI calculator , such as the one provided by AARP. One session every week for the first month. Monthly sessions for a further six months (7 through 12) if you have lost at least 6.6 pounds by the sixth month. But you have to wait six months before Medicare will pay for you to try again, officials say. There is no limit to how many attempts you can make, provided that your body mass is still 30 or greater and that six months have gone by since the last attempt. So you need to know that the program is officially called “Intensive Behavioral Therapy for Obesity,” and doctors should use billing code G 0447 to submit to Medicare for reimbursement. A recent study by the Center for Weight and Eating Disorders at the University of Pennsylvania showed that such counseling can work well, even in sessions lasting only five to seven minutes. Still, obesity experts have welcomed the Medicare coverage as an important step in encouraging both doctors and patients to treat the issue seriously.
For many patients, the risk of death from not having the weight loss surgery is greater than the risks from the possible complications of having the procedure. That is the key reason that in 2003, approximately 100,000 weight loss surgical procedures were performed and why the American Society for Metabolic & Bariatric Surgery estimated that 140,000 weight loss surgical procedures were performed in 2004. Weight Loss Surgery. Occasionally a weight loss procedure will be considered for someone with a BMI of 35 or higher if the patient's physician determines that obesity-related health conditions have resulted in a medical need for weight reduction and, in the doctor's opinion, surgery appears to be the only way to accomplish the targeted weight loss. Most Bariatric surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery. Moving from diet to diet in a cycle of weight gain and loss — yo-yo dieting — that stresses the heart, kidneys and other organs can also be a health risk. If diet and behavior modifications have failed you and surgery is your next option, it is important to understand that diet and behavior modification will be instrumental to sustained weight loss after your surgery. Incorporating exercise into your daily activities will improve your overall health and is important for any long-term weight management program, including weight loss surgery. Diet and exercise play a key role in successful weight loss after surgery. The results of most studies show that patients on drug therapy lose around 10 percent of their excess weight and that the weight loss plateaus after six to eight months.