Medicare Coverage for Bariatric Surgery Candidates in Jacksonville FL
Medicare covers bariatric surgery when all qualification criteria are met. Private insurance companies often follow Medicare in the procedures that are covered, and which are considered experimental or excluded. Medicare covers gastric sleeve, gastric bypass, duodenal switch and the gastric band, the latter of which we do not perform due to potential longer-term complications. Medicare does not cover experimental procedures or the gastric balloon.
Pre-authorization for Medicare Coverage of Bariatric Surgery
One significant difference between most private insurance companies and Medicare is the preauthorization process. Specifically, Medicare does not offer such an option. This makes preparation for surgery even more important. Patients should pay particular attention to the qualifying criteria imposed by Medicare and understand their potential out of pocket expense by scrutinizing their policy, calling Medicare, and speaking to our billing department.
For Medicare to cover a qualifying bariatric procedure, the following basic criteria must be met. It is important to understand your policy fully, so use this only as a guide, and verify criteria independently.
- Body Mass Index is the primary qualification factor for bariatric surgery and Medicare requires a BMI of 35 or more with at least one comorbidity or disease associated with obesity
- Medicare requires that the patient has been suffered from obesity for at least five years, documented either by a medical professional or using other means such as photos and supporting documentation
- Participation in a medical weight loss program supervised by a physician
- A letter from your doctor stating that weight loss surgery is medically necessary
- A routine psych evaluation
- Having the procedure at a qualified facility
If you are considering bariatric surgery through Medicare, congratulations! You have taken the first, very significant step toward improving your health. However, as with any insurance coverage it is very important that you understand the requirements expected of you from Medicare and take the time to prepare the supporting documentation to ensure coverage. We will endeavor to assist you as much as we can and will help arrange the proper preoperative care and testing.