Question:
Anyone been denied by Medicare for RNY
I am on Medicare and with that said, they want three yrs of documented efforts on losing weight by taking diet meds, I said there is not a doctor out there that would give me, with diabetes and highblood pressure, sleep apnea to have me on diet medication, so I got a call about a month ago, I was told I was approved, thinking by Medicare, I then had a question and someone from the Bariactric office, said I was approved by their dept, and that I would have the surgery, an then my claim will be sent to Medicare, now isn't that alittle backwards? Is there anyone out there waiting for approval by Medicare? Appreciate any feedback. gail — wopah7 (posted on November 1, 2005)
October 31, 2005
Hi Gail,
I had surgery on 8/23/05 and I am also on medicare--"Thank God".
Now my understanding of this payment thing (I may be wrong), is that
Medicare will pay 80% of your bills, just like regular insurance and you
are responsible for the other 20%. I was fortunate to also have Medicaid,
which took care of the other 20%. How I know that we are responsible for
the other 20% is two days before my surgery I received a call from the
Insurance person at my Dr's office stating I owed this amount of money
before the procedure could be done. After I stated that I also was on
Medicaid also her tone changed and she said "Oh, I didn't have that in
your records, don't worry about anything then." And I haven't heard
anything else about this and when I received my statements from Medicare
everything was "Paid In Full".
— mischief85
October 31, 2005
I too, am on Medicare from S.S. disability. I was told that because it was
SSD and not SSI, I was a shoe in for the surgery. It took one week from
the time the paper work was submitted to be approved. Don't give up. Stay
in contact with the doctors office. Good luck and God bless.
RNY Lap 6/16/05 292/198
— LilaDove
November 1, 2005
Medicare will not pre-approve anything. Your doctor may submit paperwork
but Medicare doesn't work like that. Medicare will pay for anything that
is medically necessary. You will have documentation of your diabetes and
other obesity related illnesses in case medicare denies your claim then you
will need to file an appeal to medicare. Hope this helps you and also you
can call 1-800-MEDICARE to verify this information. Best of luck.
— Irislady
November 1, 2005
Hi Gail...I too have Medicare (entitlement from kidney failure) and I am
almost two months out from my open RNY. I didn't have any problems getting
approved through Medicare. They are my secondary insurance but they were
the only one that would cover it. They covered 80% of 25 grand which is a
good chunk. I was told the only requirement needed for Medicare to approve
was to have co-morbidities (such as hypertension, diabetes or like the
sleep apnea). You should not be experiencing these kind of difficulties! I
would contact Medicare directly and ask what their qualification process is
for this surgery. Good luck dear!
— Pamela B.
November 1, 2005
Gail,
I also have medicare and they told me I would have to have surgery first
and then medicare would approve. i was worried too because if they didn't
pay, I didn't have that kind of money. I am also on Keystone Mercy
(medicare), and they picked up what they other didn't pay for. I was in for
8 days (I have a clotting disorder and it extended my stay) and I didn't
have to pay for anything but the nutrition appt. Good luck and keep the
faith. My co-morbs were sleep apnea and high blood pressure.
Lisa Hackenburg lap/rny 10-23-03 340/170/??? -170lbs
— Lisa H.
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