Medicare approvals

Hi, I've been reading post on here an I am a little concerned. I have Medicare and they don't pre-approve. This worries me a lot since the surgery is so much money. I was told by my N.P. that I would have to sign something at the hospital saying I would pay if insurance didn't. She then said she has never had it come back saying it wouldn't pay. I think this is a big chance to take since my husband is retired and I am disabled.

I read on here not to long ago about a girl who was told things by her doctor and found out this information was not correct. I'm wondering how much I should trust what they tell me. I am going to have surgery but the question is should I take a chance and have it in the states where I may have to pay $20 to $30 thousand or should I just do more research into Mexico and go there for $5 including traveling? My husband thinks I should opt for Mexico. What do you think?

Is the information you've gotten about Medicare not pre-approving from the NP?  Or is it from Medicare?  

Gwen asks a valid question - have you confirmed with Medicare that they don't pre-approve.

If Medicare, in fact, does not pre-approve, maybe you can purchase other insurance until you have surgery.  Does Fallon cover your area?  I pay $65/month for my coverage.  Only Fallon had to approve my surgery.  It might be something to look into in addition to considering Mexico.  You can always drop Fallon, or any other insurance, in the future.

I know you're struggling with your decision, but there are other options to check out.

Good luck!

Medicare does not pre-approve WLS. If you meet their criteria (when I had my WLS, the criteria was a BMI of 40 or above OR a BMI of 35-39 IF you had a weight related health problem like sleep apnea or high blood pressure), you have surgery and they pay.  It's super simple.

Um.... you can't have surgery in Mexico for $5.

If you have Medicare and meet their criteria, they will pay for your surgery.  So I would have it here and let them pay for it.  Why does your husband think you should go to Mexico when you have excellent insurance that covers WLS?

If you don't trust what your surgeon's office is telling you, call 800-MEDICARE and ask them.  They will explain that they don't pre-approve WLS and what criteria you must meet in order for them to pay for your surgery.  If you meet the criteria, they must  pay for it.  They cannot just arbitrarily decide not to pay.

First I had to laugh when I read the $5 thing I meant to say 5 thousand I guess I left out a few 0's sorry. I did confirm this with Medicare and they do not pre-approve. I do have another insurance but Medicare has to be billed first and if Medicare says not medically necessary instead of a simple no then the other insurance won't cover it either. Here is my problem I guess I'm reading to many posts. One girl had said they told her they go by your start weight and they didn't for her. She ended up losing weight so her BMI went below 40 and she was denied due to no comorbidities I do have comorbidities but mine are so small that they only show up some of the time. Like my Blood pressure it is only some times they gave me water pills and that took care of that, then my cholesterol I am taking meds but the lowest dose possible and the doc said he has me on them more for preventing me from having it later in life. My sleep apnea is such a mild case that the doc has me on a cpap but the insurance won't pay for any of the supplies they say not medically necessary, and last once in a while my blood will come back as pre-diabetic. And my back problem isn't from my weight. Since all these are so low I'm am afraid Medicare will say not medically necessary if I go below a BMI of 40. I seem to be loosing weight fast and I haven't started my 6 month medically supervise diet. I don't mind doing all the time and appointments to get ready for this surgery  I have all my appointments made already right up to seeing the surgeon in Sept. I am just very worried about having to pay so much money on a maybe. I've talked with Medicare and they keep saying is if we pay but we can't tell you that we will. This is scary stuff.

Does Medicare require a six month medically supervised diet?  They did not require one back when I had my surgery, but that was in 2008.

yes

Actually it  depends on the regions...so not always. They did NOT require ont in 2011 either.

but not if your BMI is 60 or over, mine is but I know yours is not.