Question:
Has anyone had the surgery (with Medicare) and then had them not want to pay?

I am in the process of pre-qualifying for surgery (initial appointment with surgeon and testing), and there is a concern that has surfaced. What if I were to get through the surgery and then have Medicare say they won't pay for the surgery? I don't have the resources or the mental strength to cope with bills of that magnitude. Does anyone have any help for me? Julia Lefmann    — Julia L. (posted on May 10, 2001)

May 10, 2001
I have Medicare. I was told they do not pre-approve and my surgeon wasn't worried. He works for the hospital and they said they would pay...they have denied the charges BUT have paid all pre op testing, and office visits. The hospital said they have to change a code and resubmit and they will be paid...BTW...on the EOb I recieved from medicare it said "since it seems you did not know Medicare would not cover these services, you do not have to pay for them. Do not pay the Doctor directly". If the surgeon is a medicare participating provider they must have some experience with this issue and I am sure they know how to get paid...Besides, how can Medicare pay for all the other surgery related testing (they did pay the anesthesia too) I am sure they will eventually pay for the surgery.
   — Kathy831

May 11, 2001
I'm a medical billing manager, Unless the Doc has you sign a waiver beforehand, its called an ABN,Advanced Beneficiary Notice, they CAN NOT bill you! They will need to write it off unless they can appeal with medical records to show medical necessity. But that's between the Docs and Medicare.
   — Karla K.