Plastric surgery (Medicare)
Bev,
I have Medicare Plus Blue and am in the middle of a fight right now trying to get Medicare to at the very least pay for a panniculectomy. (I had my surgery in July 2005 and have lost over 160lbs.) They have all kinds of criteria and some pretty strange "hoops" you have to jump thru before they will pay.
For Ex. Your pannus (apron of fat on the lower abdomen) has to hang low enough so that no pubic hair is visible. If it does not hang that low, they determine that a panniculectomy is not necessary.
Also, I was told they never pre-approve this surgery. So, the best I have found so far is a surgeon who will accept my insurance, BUT, I must pay his surgical fee up front. Which is a chunk of change that we will be hard pressed to come up with. Then, post op, IF they approve the surgery, I will be re-reimbursed the fee I paid.
It's a big gamble. But, he is just covering his own butt in making sure that at least HE is paid and doesn't care where the cash comes from as long as he gets it. I guess for him, the hospital, anesthesiologists, etc. are on their own in terms of receiving payment.
This is just the beginning of their very unusual list of pre-op criteria. This has been such a nightmare for me that simply talking about it here is ******g me off so that's all I'll say about it for now.
Good luck.
Pam
I have Medicare Plus Blue and am in the middle of a fight right now trying to get Medicare to at the very least pay for a panniculectomy. (I had my surgery in July 2005 and have lost over 160lbs.) They have all kinds of criteria and some pretty strange "hoops" you have to jump thru before they will pay.
For Ex. Your pannus (apron of fat on the lower abdomen) has to hang low enough so that no pubic hair is visible. If it does not hang that low, they determine that a panniculectomy is not necessary.
Also, I was told they never pre-approve this surgery. So, the best I have found so far is a surgeon who will accept my insurance, BUT, I must pay his surgical fee up front. Which is a chunk of change that we will be hard pressed to come up with. Then, post op, IF they approve the surgery, I will be re-reimbursed the fee I paid.
It's a big gamble. But, he is just covering his own butt in making sure that at least HE is paid and doesn't care where the cash comes from as long as he gets it. I guess for him, the hospital, anesthesiologists, etc. are on their own in terms of receiving payment.This is just the beginning of their very unusual list of pre-op criteria. This has been such a nightmare for me that simply talking about it here is ******g me off so that's all I'll say about it for now.
Good luck.
Pam
Pam,
I just saw Dr. Alfonso today for my first consultation. I'm on Medicare/Medicaid (SSI Disability) and he said that normally Medicare/Medicaid only approves the penni...but I need the full abdominoplasty. I guess they're going to contact my insurance and see what they say. I do know that the apron hangs low enough and is so heavy it cuts off the circulation in my legs when I sit down (as it rests on my thighs). The pain from carrying this around my hips is excruciating, and I do get the bad rashes often under the folds (candidias -- sp?).
I was referred to Dr. Alfonso by MMPC, btw.
-Tam
I just saw Dr. Alfonso today for my first consultation. I'm on Medicare/Medicaid (SSI Disability) and he said that normally Medicare/Medicaid only approves the penni...but I need the full abdominoplasty. I guess they're going to contact my insurance and see what they say. I do know that the apron hangs low enough and is so heavy it cuts off the circulation in my legs when I sit down (as it rests on my thighs). The pain from carrying this around my hips is excruciating, and I do get the bad rashes often under the folds (candidias -- sp?).
I was referred to Dr. Alfonso by MMPC, btw.
-Tam
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