Medicare & Surgical Question

I would be interested hearing from anyone that has had their wls & did medicare pay for your surgery? I do have BCBS as secondary, will they pick anything up? If not do they bill the patient? As much as I want this surgery I just can't put myself in debt for it. MMPC told me that I was approved, medicare would cover it, but I have since switched to Hurly and they have required I have an upper GI and a stress test......I got my results today. I have a small hiatal hernia and reflux, will this create a problem for surgery? I called Hurley but she gal couldn't really give me an answer. Seems like things progressed at a faster pace with MMPC and you got direct answers with MMPC. Connie

I had Medicare and HAP. Medicare paid first, then HAP paid the remainder.

Hi. I don't have medicare so I can't answer your question regarding how much they pay. However, I did have a very serious case of reflux, but no hiatal hernia. I was taking Aciphex for the acid reflux. But I haven't taken it since the day before my surgery. Haven't needed it, either. The only pre-op test I was required was my psych-eval. I had my surgery at Hurley. I know everyone's pre-op testing is different. I had my initial consultation at the beginning of April of 05. Once the insurance company recieved the results of my psych eval (which were drug out for six weeks...I was not happy with the dr. for that), I was approved about a day later. Then Hurley scheduled my pre-admission testing and my surgery. If Dr. Farhan hadn't been on vacation for the month of July, I could've had my surgery in July. But as it were, I had it August 11th, 2005. So it was a relatively quick process for me. They were very good at answering any questions I had or returning my calls. I hope things go well for you! Waiting can be so stressful! Take Care, Tina 335/206/150-ish

i had medicare as my primary and medicaid as my secondary. i was never charged one cent. it was all paid for.

Medciare will pay 80 percent after your yearly deductilbe and Blue cross will pick up the remaining 20 percent. With medicare you have to go to a center of excellence which is MMPC or Hurley plus you need to have part A for inpatient and part B for the outpatient testing. Plus Medicare big thing is medical necessity or things will not be covered without the right coding. Hurley is new with being a center of health excellenc so they probally have not had alot of medicare patients like MMPC so that is why they probally could not give you the answers. Tricia

Hi Connie, I had my surgery four years ago at Hurly. My insurance was medicare and BCBS. Between the two all my bills were paid. Hurly did all the paper work. I have reflex and a hiatal hernia. It didn't cause any problem with the surgery. They told me that most of the time the surgery stops the reflex. Good Luck. Ruth