Medicare National Coverage Decision and its Effect on Patients

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Were you impacted by the February 2006 Medicare decision regarding bariatric surgery?

If you were personally impacted by this decision as a patient seeking bariatric surgery, either positively or negatively, we want to hear from you!

Please let us know how the Medicare NCD personally affected you. If your surgery was cancelled, please let us know if you have been rescheduled, identified and begun the process of accessing surgery at a different bariatric program or have been unsuccessful in finding a program to perform your surgery. For those of you that have been unable to find a program to perform your procedure, please let us know what barriers you have faced.

We also would like to hear from those of you that have positive experiences with the new ruling. For example, those of you that were able to access adjustable gastric banding or the duodenal switch.

The OAC will summarize any information received and share it with the leaders at Medicare and with the other key parties interested in improving access to bariatric surgery.

Please send your responses to the OAC at info@obesityaction.org. If you are a bariatric surgeon, coordinator or allied healthcare professional, we urge you to distribute this message to your impacted patients so that they may respond to us directly.

To read a positive result from the Medicare NCD, please see the below story:

A Real Impact
June 1, 2006

I was scheduled for gastric bypass surgery on March 13, 2006. It had taken me almost a year to get here. I had been turned down by my insurance three times, so I decided to go with my primary insurance (Medicare). 

I had all my pre-op work done, and three days before my surgery, my surgeon’s office called and told me it would have to be cancelled because of the change with Medicare. I had been scheduled for over a month. I called Medicare on my own asking questions and telling them that I had been scheduled before the change, but it didn’t matter. They said they wouldn’t pay for it.

I went on a message board, and after telling everyone how upset I was, someone directed  me to a Web site to find Centers of Excellence (COE) in Florida. I found one five minutes away, but my husband had wanted the same surgery with the same surgeon two years ago and that surgeon wouldn’t accept Medicare.

I called the office the very next day and was told the surgeon is now taking Medicare. However, it was one month before I could get in to see him. I waited, went to see him, then had to wait another month because they had to send yet another request to my secondary insurance for the surgery.

However, I am very excited to let you know that I am having laparoscopic gastric bypass surgery Tuesday, June 6, 2006.

It was frustrating and aggravating when I had waited so long, given my down payment, completed my pre-op work, only to be cancelled because Medicare did not grandfather those who were scheduled before the change took place.

Although I’m extremely excited about my surgery, I’m sad it’s not with a surgeon I trusted and came to love. I’ll never forget the distress I felt when I was cancelled.

Sincerely,

Elizabeth H. Myers, Ocala, FL



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