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Timeline for Surgery Through Medicare

N

Neecey

Member
I’m attending an info session (virtually) this Thursday and made my initial appointment with the surgeon that came recommended to me for gastric sleeve surgery. I was so disappointed, though, that his first available was May 25. That’s over two months away!

I know I have to be on a weight loss program to meet Medicare requirements before I can have the surgery. Can anybody tell me how long Medicare requires you to be on that program? 3 months? 6 months? And how long after that to get the surgery?

I’d really appreciate timelines for those of you who went through Medicare for your gastric sleeve surgery. I so wanted to have the surgery by September but I have a feeling that’s not going to happen if I can’t see the doctor until May 25.
 
I have Medicare and was able to go from first appointment with my bariatric center (and met the surgeon on the first appointment) to a scheduled surgery date 2 1/2 months later. Maybe it moved very swiftly because all but one of my doctors belonged to the same medical center and they made all my appointments for me. The only one I had to make a phone call to was for a colonoscopy as I already had a doctor for that in another practice.

But, Covid shut down elective surgeries so I actually had to wait another 2 1/2 months. You should get through pretty quickly unless for some reason you have long waits for individual pre-surgical tests with various doctors. Good luck!
 
You should ask your surgeon. It was different way back when I had RYGB in 2007. My surgeon had to write a letter to Medicare saying I was 100 pounds overweight and close to the typical comorbidities. He scheduled me before even mailing the letter. Then he had his annual vacation scheduled so told the clerical staff to schedule me for the earliest possible date after. He suggested i should see if i could drop a few pounds before surgery. Total elapsed time was a few weeks.

Most people nowadays have a six-month ramp-up. They spend that time learning and practicing new eating habits.
 
I have Medicare, not an advantage plan, and I wasn't aware of a waiting requirement. Now the Advantage plan is through a private insurance company and I do under stand most do have a 6 month requirement. My surgeon gave me a sheet to give my GP on how to write a letter to Medicare listing my weight over a couple of years and my BMI. less then 2 months I was approved. I still had to lose weight per the surgeon have the phys. evaluation, stress test, upper GI, and meet with the nutritionist. I should have had my surgery in a little over 3 months. but the person handling my misplaced my paperwork and that held me up for another month, or so. But all together it took around 5 months for me.
 
This is all so upsetting for me because I need TKR surgery on both knees and it’s getting so bad that I can barely walk. I’m in constant pain yet the ortho surgeons won’t operate until my BMI is under 40. I still have two months before my appt with my bariatric surgeon. 6 mos wait for Medicare. Sleeve surgery then (hopefully) weight loss. So we’re talking another YEAR to get my knees fixed. By then I’ll be in a wheelchair.

I’ve been trying to get below 40 BMI for nearly 3 years; was 1.5 points away when the pandemic hit. Gained it all back. Story of my life.
 
Neecey said:
This is all so upsetting for me because I need TKR surgery on both knees and it’s getting so bad that I can barely walk. I’m in constant pain yet the ortho surgeons won’t operate until my BMI is under 40. I still have two months before my appt with my bariatric surgeon. 6 mos wait for Medicare. Sleeve surgery then (hopefully) weight loss. So we’re talking another YEAR to get my knees fixed. By then I’ll be in a wheelchair.

I’ve been trying to get below 40 BMI for nearly 3 years; was 1.5 points away when the pandemic hit. Gained it all back. Story of my life.
Click to expand...

I know how hard it is to wait for those knee replacements. I was told I needed them at age 40 but I was too young. At 50 I was able to get them but was in tremendous pain which led to immobility and more weight gain. I do feel for you and know it is not fun.

I hear more and more surgeons these days say that they won't do knee replacement unless you lose weight. I guess I was lucky that my surgeon didn't require it 15 years ago. I even asked him if it would be an issue and he said no. There may be new findings that lead them to believe it is better to lose the weight first or maybe it is insurance companies calling the shots. Fortunately my knees have held up well. I went to the Hospital for Special Surgery in NYC where they were on the cutting edge of knee replacements, so I don't believe it was a lack of knowledge on my surgeon's part.

Anyway, hang in there. You will feel somewhat better with every pound of weight you lose, although you will still need the replacements. And your recuperation from knee surgery will be easier having lost the weight. Try to stay focused on the prize... that you will see a better quality of life, one step at a time.
 
I feel your pain. My knees were totally worn out and I had to have TKR on both around 10 years ago. I had them done 1 year apart. I learned a lot on the first one ane that made the second a lot easier. Trust me, I road a recumbent bike, did leg lifts, lifted light weights. Anything to try to build core strength. It will make all 3 surgeries a whole lot easier. And recovery faster. Tip, if you get the knees done at different times, just getting in and out of bed is really painful. Sit on the edge of the bed, put the foot of the good leg behind the foot of the operated leg and use it to help lift the operated leg To lay down and get up. But you will be a whole new person with new knees and the bariatric surgery. They will be worth it.
 
I have failed back surgery syndrome and am in constant pain also and barely able to walk. There was a period that I had to use a wheelchair and I actually found it freeing. Really! I could get around without pain and actually go places. I find it best to just accept what I can't change, say "O, well." and roll with it. If you have to use a wheelchair, take solace in the fact that it won't be forever and be proud of yourself for doing what you must do to better your health. I had a friend who got both her knees done at the same time. She had help at home though. She said she wouldn't have had it any other way-half the recovery time!
 
Neecey said:
This is all so upsetting for me because I need TKR surgery on both knees and it’s getting so bad that I can barely walk. I’m in constant pain yet the ortho surgeons won’t operate until my BMI is under 40. I still have two months before my appt with my bariatric surgeon. 6 mos wait for Medicare. Sleeve surgery then (hopefully) weight loss. So we’re talking another YEAR to get my knees fixed. By then I’ll be in a wheelchair.

I’ve been trying to get below 40 BMI for nearly 3 years; was 1.5 points away when the pandemic hit. Gained it all back. Story of my life.
Click to expand...
I understand where you are with the knee issues. I had both replaced three years ago at 68. My knee issues began when I was in my mid 30s and about 130 lbs. Needless to say the gradual increase in knee pain went along with my decreased activity level and increase in weight. Everyone assumed my weight caused my knee issues. Unfortunately with mobility issues it makes weight loss more of a challenge. One bit of advise I was given by others and found to be true that I pass on about knee replacement is to be very dedicated in the rehab after the surgery. Push yourself because the more you do early will determine the range of movement and speed your recovery. Because I had already had the knee replacements my Dr. said that I qualified for WLG and that Medicare would cover the cost. As soon as I agreed to a consultation with the surgeon she made the appointment. He gave me a surgery date for the sleeve that very day in 4 months. Good luck, Caterina
 
I have Medicare, and have been told that the requirement is a minimum bmi of 35 with one coexisting condition such as diabetes or sleep apnea, etc. The wait period is 3 months with mandatory visits at least monthly with nutritionist, surgeon, bariatric coordinator, letter from psychologist or psychiatrist, and compliance with regular exercise routine. I think that was it. I had my first visit with my surgeon first week of May, and am hoping to have my surgery early August, if all goes as planned.

If there is no other preexisting condition, the minimum bmi has to be 40. The other requirements are all the same.

There does seem to be a lot of difference in people's experience with this. I will let you know if mine stays on schedule.

Kathi
 
I have Medicare and they required 6 monthly visits with the surgeon, 2 Dietitian visits and one psychologist visit. The minimum BMI was 34 with coexisting conditions. I did not have to follow a special diet or exercise routine, nor did I need to lose weight before surgery. I had the rny gastric bypass surgery this past April (12).
 
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