The RNY Surgery & Medicare?

I have my second and final meeting with my surgeon on February 12th and they will schedule my pre-op stuff and the surgery.  My question is.... Has anyone had this procedure done and had Medicare insurance?   With most insurances, the surgeons office have to request pre-authorizations and the insurance companies have to approve the patient so that the procedure will be covered.  With Medicare, it is completely and so different.  The patient must sign "Advance beneficiary notices" which state that I know that Medicare hasn't decided to pay and if they do not, then I am responsible.  I have to sign one for the surgeon and one for the hospital.  Then, after the surgery, the surgeons office submits all the info to Medicare and they will make their decision, based on the situation and the Co-morbidities and patients health.  I am just curious if anyone on this message board has had to go through this with Medicare and if they'd be willing to share their experience.   Thanks for listening to me babble.  I tend to type like I talk.  Will be awaiting replies.  Theresa

Nah! dear you aren't babbling at all!  We all are on here are for support and ask Q'and try to answer them as well. Sorry ! I dont have any answers for ya but i wanted to stop in to say hello !  Hope your surgery goes well !  welcome to our family here!  do keep us posted and pray things work out for you and your surgery too! God bless BONNY

Theresa, I don't have any insight on this. You may want to cross post this on the INSURANCE FORUM. I surely hope that your surgery is approved! February 12th is right around the corner. Let us know your date so we can  cheer you on

Thanks for replying and for the suggestion.  I will definitely do that if I can find the Insurance forum.  I am only a week or so on this site and it is so slammed with everything helpful that I am feeling a bit overwhelmed but I do LOVE it here.  Since I wont know if Medicare is going to pay or not until afterwards, I am just going to sign the forms they want me too and have it done.  I mean I dont think I have much choice.  34 yrs old, 4 lung diseases, diabetes & CHF...  It would be the smart move to help me with this.  Either way, I will have it done.  Just not soon enough.  Thanks again and I will let ya know. Hugs, Theresa

Here ya go!   http://www.obesityhelp.com/forums/insurance/a,messageboard /board_id,5363/

Thanks so much Jen. I  copied & posted my post from here and posted it in there.  I am sure I will get much needed information.  Thanks so much for the suggestion.  I just adore this website.  I have been made to feel very welcomed.  Thanks again. Theresa

Good pm Theresa, You aren't babbling! You are asking a great question that some folks here might be able to shed some light on & educate us all on it. I've not dealt with Medicare before but wanted to wish you the best with your upcoming surgery. Please keep us posted. All best...

Thanks so much for the well wishes.  If I could get a handle on this whole Medicare will approve or deny you after the surgery thing, I may not be so stressed!  Lol.  I will definitely keep ya posted since we are practically neighbors.  Again thanks...  Theresa

Hi, I have Medicare and am currantly awaiting surgery. My surgeun required preapproveal which required me to undergo 6 months of supervised diet by a physician or nutritionist by Medicare. I believe you also had to have a BMI of 40 or over as a requirement for approval. I have finished all that so nothing else is required. I am surprised your doctors insurance person didn't tell you about the new requirement.Sorry I dont have any more info than that. Pam

Yes, those are the requirements but when it comes time for the surgeons office to submit all your paperwork and the proof that you've completed all your requirements, it is not done until after the surgery.  Medicare does make you complete all those things but they will not decide to pay or not until after the surgery.  That is when the paperwork will be submitted to Medicare for the approval process. I have done everything that you mentioned, which is required and they also make you go through a psychological evaluation as well, which I have done.  I just get frustrated that they won't decide to pay or not until after you have done it.  You may want to ask your surgeons office about that as well and about the Advanced beneficiary notices that Medicare makes you sign too.   I am curious as to what it's like dealing with Medicare and the approval or denial process after the surgery.  I do appreciate you writing me back.  Please keep me posted on your progress with wonderful Medicare and good luck on your journey hun! Theresa