Medicare and RNY

I had a surgical date for 2/13 for a gastric sleeve procedure, yesterday the insurance called and said my final approval has been denied. Medicare apparently does not cover the sleeve. My docto'rs business coordinator said that she knows they cover RNY and lap band. Does anyone have a appx cost of what the price would be after medicare pays.

 I have medicare and sofar I have just gotten a few bills for the dr.  I have not gotten anything else yet.  If you haven't covered your diductible yet, you will have to pay that.  I know that medicare doesn't "preauthorize"  That was a big thing they kept telling me.  So in other words they put you through all the loops for the surgery, give you the surgery, and then medicare decides if you are a good fit for it after the fact.  In simple terms, you better have a good billing office working on your behalf that makes sure you did match all of the qualifications BEFORE you go into the surgery, or else you may have to file your own appeal.  I haven't had to do any of that yet.  Just do your research.  Good Luck!!

My surgeon's office makes you pay your portion up front. Medicare pays 80 percent, and you are responsible for the remaining 20 percent. At my surgeons office, that came out to a little over 1300, and that is including the hospital costs and everything. I am all paid, and ready to go next Monday!!

Good luck!!

Medicare has two parts, A & B. Part A pays for hospitalization. If your surgery is considered inpatient (staying 2 or more nights), it will be covered by Part A. For 2012, the Part A deductible is $1,156.00.  You would owe this amount to the hospital. 

Part B covers doctors' fees and outpatient tests and procedures. If you are going to be in the hospital just overnight, it is likely your surgery is considered outpatient and it would all be covered under Part B. For 2012, the deductible for Part B is $140.00. After the deductible is met, Medicare pays 80% of the Medicare Fee schedule and the patient is responsible for 20%.  The Medicare Fee schedule is not the same as total charges -- your doc could charge $600 for a procedure but the Medicare fee schedule for that procedure might be $250. In this example, Medicare would pay $200 and you would be responsible for $50. I would think your doc's business coordinator could give you some idea of what kind of patient responsiblity they typically see for their Medicare patients. Also, if your surgery is outpatient, the hospital should be able to give you a general idea of how much your 20% for the surgery is likely to be.

some of also have a Medicare supplemental plan so we dont' have to pay the Part A deductible or 20%, I never pay anything for anything

I have medicare and had to pay $585, up front. This amount was 225 for processing and paperwork and the rest was what wasn't covered for dietary. Otherwise, I didn't have to pay anything else. I'm not sure but aren't states all different in what they cover?

i can't believe they charge you to file the paperwork - that is crazy - that is the surgeons office job, I have never heard of that before.  there is no way I would have paid that

I actually have Medi-cal,  and I had to pay 500 for the psych appt, and 80 for the NUT appt.

Michelle

I have medi cal too and only paid 250 for  the psych evaluation..Everything else is covered 100 percent.

It has been 5 months tomorrow and I haven't had to pay anything. We have Medicare A and B, plus AARP. Our monthly insurance is significant so we never do pay for office visits, lab fees, or surgery. I did have to write a check for psychological fee.