Dear Medicare Patient,

If you are planning to use Medicare to cover the Lap Band surgery, below is a list of requirements that you will be asked to comply with:  
 
NOTE:  YOU MUST HAVE MEDICARE PARTS A & B COVERAGE
 
Medicare List – You will need the following:
 
1) A letter of “Medical Necessity” from your     Primary Care Physician (PCP)      stating why     they feel you would benefit from Bariatric     surgery (Lap Band).

*When approaching your Doctor for a letter     of Medical Necessity, please keep in mind     that Medicare is looking for one of the     following major co-morbidities for Lap Band     Surgery approval:

    A. Diabetes
    B. Sleep Apnea
    C. Hypertension
    D. Arthritis
 
If you have other major health issues, please ask your Doctor to include these in his letter as well. **This letter should be on your Physician’s letter  head.
 
2) A Psychiatric or Psychological clearance.
 
3) Pulmonary Evaluation (Pulmonary Function Test) giving the patient clearance to undergo Bariatric surgery.
 
4) Cardiology Evaluation (Stress Test) clearing the patient to undergo Bariatric surgery.
 
5) Letter of Favorable Decision from Social Security stating why the patient is receiving disability.  (Go to your local SS Office and they can provide you this letter).
 
6) The Medical Questionnaire, provided by Beliteweight, must be filled out and sent back to us. You may be asked to have additional tests done by the physicians.
 
7) Copy of your Medicare Card & drivers license.

**NOTE: All of the above needs to be completed and sent to us for an “OK” from our Doctors first, before we give you, the patient, a confirmed surgery date.  
 
BCBS of Michigan
If the patient has BCBS of Michigan, all of the above is required along with 12 months documented weight loss history that was supervised by a Physician.
(Weight Watchers and Jenny Craig for example do not count)
 
BCBS patients will not have a letter of favorable decision.  
 
When you have all of the above information completed, please fax to our office at: (888) 211-8548. You should keep the original copies for your records.
 
Thank you for your cooperation. Following these steps will help us a great deal.  
~Beliteweight