If you’re considering gastric bypass surgery, one of your first questions is likely whether or not Medicare will cover the cost. Unfortunately, there’s no simple answer. The rules and regulations for who Medicare Advantage Insurance Plans covers and who it doesn’t, can be complex to navigate. In this article, we’ll break down what you need to know about how Medicare handles bariatric surgeries like gastric bypasses to help make sure that you have in-detailed insights.
What is Gastric Bypass Surgery?
Gastric Bypass Surgery Las Cruces has been shown to be effective in helping people lose weight and maintain their weight loss over time. It helps people lose weight by reducing the size of their stomachs. In fact, it is one of the most common types of bariatric surgery.
The surgery involves cutting away part of the stomach and reconnecting it to the small intestine. This creates a smaller stomach pouch that can hold less food, which helps patients feel full after eating fewer calories.
Who can Get the Surgery Covered by Medicare?
Gastric bypass surgery is considered “medically necessary” by Medicare if you meet all of these criteria:
The term medically necessary means that the procedure or service must be what a doctor would consider appropriate for your condition. The fact that it’s covered under Medicare doesn’t necessarily mean every patient will get bariatric surgery paid for by their insurance company. Still, patients who meet the criteria generally should expect to have most (if not all) of their surgeries reimbursed through traditional Medicare plans.
There are some exceptions, so check with your plan administrator to determine whether you are a candidate for gastric bypass or sleeve to cover costs in full or require you to pay upfront and then file an appeal later on.
When does Medicare Cover Gastric Bypass Surgery?
Medicare covers bariatric surgery as long as your doctor considers it medically necessary for you. Generally, this means that they feel the procedure will provide health benefits beyond traditional treatments and is a better option than just continuing to treat with diet and exercise alone. However, there are some exceptions: Medicare won’t cover surgeries if your doctor decides that doing so would be too risky or potentially dangerous in light of other medical conditions you have at the time.
The criteria can also change over time; for example, certain gastric bypasses require patients to stay overnight after leaving the hospital, but newer procedures allow them to go home on the same day instead. If you’re considering joining one of these programs, make sure that you find out from your insurance company if they cover the cost of home surgery.
To Conclude
Medicare coverage for gastric bypass surgery can be complex, but it can be rewarding too. Be sure to do your research and ask questions before deciding whether this type of weight loss surgery is right for you.
