Medicare Bariatric Surgery: Medicare Creates Coverage for Obesity Surgery

In February 2006, Medicare announced that it would cover bariatric surgery, which is surgery used to treat obesity.  Three different types of surgeries are covered:  The Roux-enY bypass, which creates a small pouch in the stomach to connect to the bowel in order to bypass most of the stomach; open and laparoscopic biliopancreatic diversions to bypass most of the small intestine and pancreas, and laparoscopic adjustable gastric banding, which pinches off part of the stomach.

Obesity rates in America are extremely high, according to experts.  Statistics show that approximately 65% of American adults are now overweight.  This has now become a national epidemic, as obesity increases the risk of heart disease, diabetes, cancer and other complications.  Americans are turning more and more to bariatric surgery. 

It used to be that Medicare only covered bariatric surgery if it was needed to correct an illness caused by or exacerbated by obesity.  There was no national coverage policy, so each state had its own.  Now, there is a uniform policy, which covers all Medicare recipients for the surgery.  The Centers for Medicaid and Medicare Services no longer require patients to try other weight-loss treatments first, as most have already made several attempts to lose weight.  To qualify, their body mass index must be over 35 and they must suffer from other weight-related issues such as diabetes or heart disease.  In addition, the surgery must be performed at a medical center approved by the American Society for Bariatric Surgery, or at a certified Level 1 Bariatric Surgery Center by the American College of Surgeons.

Advocates of the new provision claim that covering the surgery will reduce Medicare costs, as patients recover from their obesity-related health problems.  The agency estimates that the new procedure will cost less than expenses associated with heart disease, such as coronary bypass and defibrillators.  It is expected that the patients’ health will improve after surgery, and they may even be able to go off disability.  ASBS President Neil Hutcher, MD says that Medicare coverage for bariatric surgery will begin to remove the stigma of obesity and gastric-bypass surgery, and will cause private health insurance providers to follow suit.

16 Responses to Medicare Bariatric Surgery: Medicare Creates Coverage for Obesity Surgery

  • shelly says:

    My friend lives in kentucky .She is over 600 pounds and i think that qualifies her for surgery.She is unable to do regular day to day activities that you and i take for granted every day.After searching high and low she still has not been able o find a facility that accepts her medicare and medicaid.The registered bariatric centers are not accepting and she told me that she has to stay within her state .Please send me some information on the centers that accept medicare and medicaid in kentucky .I am afraid that one day i’ll get a call saying she is dead.

  • LeSheika says:

    When did medicaid stop requiring patients to have completed a supervised diet before weight loss surgery? I am going through that right now, and am having to do the 6mo supervised diet, I would love information on this if you have it available. I have tried many many diets over the years, and they just didn’t work. Thanks!

  • Ruby T. says:

    Did your friend ever check at King’s Daughters Medical Center in Ashland, KY?? They have a fairly new program there that may accept medicare/medicaid. In the meantime, I’ll look around and leave another post if I find anything promising.

  • Debbie Orr says:

    Can you please provide me with the URL or other reference material that discusses Medicare’s change in its policy that backs up this statement made on your website? Here’s the statement:

    “The Centers for Medicaid and Medicare Services no longer require patients to try other weight-loss treatments first, as most have already made several attempts to lose weight. To qualify, their body mass index must be over 35 and they must suffer from other weight-related issues such as diabetes or heart disease.”

  • Darlene Nelson says:

    Go to the websight http://www.johnhusted.com
    That is where I am seeking to go. To my knowledge they are now accepting Medicaid and medicare. He is a wonderful man. I went to the seminar the other day. Good luck.

  • Karen says:

    If you are near Louisville, I have two suggestions for you. You can go through Norton’s Bariatric Center. They have more than a dozen doctors. According to them, they do not accept medicaid but they do accept medicare patients. You can also go through Right Weigh (dot com) for Dr. Shena who is also part of the Norton program. He is my doctor and explains everything fully and makes sure you understand everything totally. If you are near Lexington, try the program at the hospital in Georgetown. Are you sure she has to stay in-state? I understand that Vanderbilt Hospital in Nashville has an excellent program. One thing, as a medicare patient, she MUST have your surgery done at a Center of Excellence. The three I mention are. Also, online search for Centers of Excellence for your city or area. I’m sure there’s more. I am currently waiting for approval from my medicare advantage company, and hopefully I should have my surgery in a couple of months.

  • april says:

    I too am in the same situation. I live in LA. and is in desperate search of on bariatric surgeon.The only coverage i have is medicaid.please help.

  • april says:

    i am in the same situation as all of u all

  • betty C Lewis says:

    I have a bmi of 44, a very large hiatal hernia. high blood pressure. sleep apnea,severe incontinence, chronic fatigue and severe shortness of breath..what are the quailfications for Medicare to pay for surgery. I have already gone to a seminar at Duke today June 1st. As far as a doctor is concerned i have qualified. I just have to have your coverage.

  • CLETIS JONES says:

    I been approved for weight loss surgery and i live in Louisiana as well.Tulane medical center is doing my surgery and several other people i know.Doctor Charles Bellows is my doctor.I am getting the gastric sleeve done.if this helps anyone in louisian YES MEDICAD COVERS IT AND YES U TOO CAN GET APPROVED

  • Catherine Ramsey Santo says:

    I live in Little Rock, Arkansas and have been trying to get the lap band surgery. I have just turned 58 and I’m on Medicare parts A and B. I also have AARP supplement insurance provided by United Health. I am also a diabetic. The clinic’s web age says it takes Medicare but they refuse to accept my application even though I meet all the requirements. Their excuse is they want a preapproval, which Medicare doesn’t provide. What do I do now? Both Dr. Wellborn is on Medicare’s list of providers and he performs at Baptist Hospital (the only hospital in the state. Is there anything I can do?

    Is

  • Di says:

    I was told that Medicare patients still had to go through the 6 month doctor supervised diet and lose 10% of my current weight before Medicare will pay for it! But that if I had Medicaid I wouldn’t have to do that. If I had Medicaid I could get the surgery right now — which a lady who was at the same seminar plans to do so that she can have another baby with her boyfriend.
    I’ve tried to lose weight for almost 20 years and if it was so easy for me to lose 10% of my weight, I’d do it! My BMI is almost 60.

    I’m not against Medicaid — people need it. I’ve needed it in the past. But it just isn’t fair that those of us on Medicare have to jump through hoops that those on Medicaid don’t have to. Medicare should be as good as Medicaid.

  • Katherine Smith says:

    The best thing is to have your family doctor refer you to a pace of ecelance, most of the time you’ll have to travel a ways, but mostgenerally it’s worth it. I’m in teh prosess of it right now and it’s the best thing that I could be doing for not just myself but my young daughter and my family also.

  • sandra says:

    im going to nortons next month for my surgery and they did except my medical card / i guess they have changed .since 2008

  • Troy Freeman says:

    I’m 39 years old and I weigh 550 lbs i’m 6foot 2 inches I havent been to a doctor in about 9 years yes i’m a ticking time bomb I know.I have recently in last year gained so much weight that I can barley walk I can’t fit into my shoes without undoing laces because my feet are so swollen now that you have a picture in your head this should tell you how bad my condition is according to the 2008 medicare guidlines for bariatric surgery I do qualify for it.
    One problem, it is March 2011 and I have heard horror stories about recent laws being passed where medicare doesnt pay for this surgery. Can you please tell me this isnt true i’m ready to do whatever it takes I don’t care I don’t want to die.

  • raylene says:

    contact dr. charles bellows at the tulane university in new orleans or his nurse brooke and as along with a dr. referral from your family physician she will help you right away.

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