Re: Medicare policy

[Guest guest]

I didn " t find it so depessing! Consider some things..

First of all, for who now has to " protein fast " :

" Supplemented fasting is a type of very low calorie weight reduction

regimen used to achieve rapid weight loss. The reduced calorie intake

is supplemented by a mixture of protein, carbohydrates, vitamins and

minerals. Serious questions exist about the safety of prolonged

adherence for 2 months or more to a very low calorie weight reduction

regimen as a general treatment of obesity, because of instances of

cardiopathology and sudden death, as well as possible loss of body

protein. Therefore, supplemented fasting is not covered as a general

treatment for obesity.

The safety of intestinal bypass surgery for treatment of obesity has

not been demonstrated. Severe adverse reactions such as steatorrhea,

electrolyte depletion, liver failure, arthralgia, hypoplasia of bone

marrow, and avitaminosis have sometimes occurred as a result of this

procedure. It does not meet the reasonable and necessary provisions

of §1862(a)(1) of the Act and is not a covered Medicare procedure. "

They make a clear distinction between obesity and MA and MO is NOT

BMI >50! You must also meet the weight req, however.

" Obesity is an increase in body weight beyond the limitation of

skeletal and physical requirements, as a result of an excessive

accumulation of fat in the body. In general, 20% to 30% above " ideal "

body weight, according to standard life insurance tables, constitutes

obesity. Morbid obesity is further defined as a condition of

consistent and uncontrollable weight gain that is characterized by a

weight which is at least 100 lbs. or 100% over ideal weight and a

body mass index (BMI) of 35 or greater. "

This is not acccording to NIH but most of us pass anyway:

" All those not listed in the " ICD-9 Codes That Support Medical

Necessity " section of this policy. Obesity (278.00) is not in and of

itself sufficient. The patient must have morbid obesity (278.01) and

another condition which was either caused by or aggravated by the

obesity. "

There's more, will post later.

F. (To distinguish between the ubiquitous Chrises around here!)

> That was incredibly depressing.....Elle

>

> >From: <pbl4Him@a...>

> >Subject: Medicare policy

> > I found medicare's policy on treatment of obesity. Quite often

insurance

> > companies use medicare's guidelines to set up there own. I did

not see a

> > date, so would think that this is the current policy. I don't

know if it

> > will be of any help, but it gives one pause to think. Medicare

doesn't

> > consider obesity an illness. I think they do believe that

alcoholism is.

> > http://www.hgsa.com/professionals/policy/g24b.html

> >

> > Pam in PA