Lap band surgery has made it possible for morbidly obese individuals to reclaim their lives and lose weight when other methods have failed. As of 2006, Medicare has acknowledged this as a procedure worth covering. People looking to fund this expensive procedure through Medicare should allow a fair amount of time for preparation. Individuals under 65 must establish qualification for coverage, especially for bariatric surgeries.
Instructions
1. Determine eligibility for the Medicare program. Contact the local branch of CMS (Centers for Medicare and Medicaid Services) or the Department of Human Services. General coverage criteria can be found on their Web sites, but contacting an agent will ensure thorough understanding of criteria and procedure.
2. Choose a surgeon or surgical center for the procedure. This is part of the qualifying process, as only Medicare-approved facilities will be covered for lap band surgery. In accordance with Medicare criteria, the American College of Surgeons must classify the facility as a Level 1 Bariatric Surgery Center. Otherwise, the American Society for Bariatric Surgery must deem the facility a Center of Excellence.
3. Send a letter to Medicare, following initial qualification, outlining the criteria that have been met to qualify for lap band coverage. These include:
- Having a BMI (Body Mass Index) of at least 35
- A co-morbidity that is a direct result of being overweight (heart conditions, diabetes, etc.)
- Detailed accounts of previous weight loss attempts that did not meet with success
4. Back up any claims made in the letter with concrete evidence. This can include:
- A referral from a primary care physician stating that the procedure has been deemed a medical necessity for the sake of the patient's health
- Receipts from weight loss centers, health clubs, etc., to indicate that attempts have been made to lose weight and that those attempts brought no results
5. Make a good case. Medicare coverage of this procedure been in effect since 2006. It is still considered on a patient-by-patient basis. Coverage is never a guarantee.
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