Medicare approvals

I don't think the girl who got denied has Medicare. In fact, I know she didn't, because Medicare neither pre-approves or pre-denies. (*grin*)

As Kelly says, if you meet Medicare's criteria, they pay. If your BMI is greater than 40, you meet their requirements, period. Your surgeon should know this.

What I'm wondering is if your surgeon is trying to avoid accepting Medicare assignment. Ask, using those specific words---"Do you accept Medicare assignment?" If they say yes, then they have to file and abide by what Medicare says. In other words, they have to accept whatever Medicare pays them, and all you can be billed is the standard 20%.

yes, you are reading too many posts and making the problems of those posters your problem . 

The person you are referencing  doesn't even have Medicare,she has regular insurance provided by her employer. W

why would you think her problems are going to be your problems? 

GL and girl,don't borrow trouble....

"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. "

This is also what I have found from Medicare and after speaking to Humana, whom I might pick up as a Medigap policy.  They will not cover if Medicare does not.

The main issue at play here is that when you just need your regular insurance company to approve, you get a yes or a no from them and that's that.  When you are looking at "we might pay but you won't know until AFTER surgery, and it's costs more than my car, that's not a comfortable place to be.  And THAT is why some of us are coming on trying to get some sort of definitive answer.  We are looking for that elusive "yes, we will cover".  If we do not accept medicare when they say we are eligible and have the card, and I think I need to look this up again (sorry) we may have some sort of penalty.  Not sure but seems I was told this.

I went out and got a second policy for this surgery and within a month later, my Medicare card showed up!  I am only 57 so was not expecting that.  Now I have to deal with them.

Hi, I am also on Medicare disability and have moda as suplimental.  Medicare doesnt pre approve WLS because you have to meet the 6mo of diet seeing a nut ,ect. But when your done with all this the doctor office will send it all in with a letter and you will be approved or disapproved before the surgery.  I dont want to have to pay the 40,000 dl for the WLS and the doctor and hospital doesnt want to either. Trust me they wont do the surgery unless they know insurance or you can afford it.  Hope this helps 

My surgeon does accept Medicare assignment and I have talked to his coordinator and Medicare.  they do not pre-approve wls and they would not tell me yea or nay about any of the wls surgeries.  It was also explained to me that with Medicare, you have the surgery and then find out if they will cover it or not.  I have 2 co-morbidities and bmi of 60 so there will be no pre-surgery diet for insurance.

The real trouble is that we read and hear so many things that it is hard to figure out if we are covered or going to go broke on it.  Heck, I'm on disability and already broke.  Nothing new there.  lol

It's not really true that you have to have surgery and then find out if they will cover it.  They tell you in advance what their criteria is for covering WLS.  If you meet that criteria, they will cover it.  No question about it.  You know, and your surgeon knows, if you meet the criteria or not.

Thanks that makes me feel better. I apologize if I made it sound like I thought the other girl had Medicare I have no idea if she did or not. I think what I was thinking in my head didn't come out right. I was trying to use her as an example of things that can go wrong with insurances. I do qualify they did tell me that but they also told me they use your starting weight and that girl was told the same thing and then they told her they aren't using her starting weight. In my head I keep hearing how much it cost and if for some reason the insurance company decides to back out. It is just SCARY STUFF and a lot of money to think about. I will feel better June 9th I am going to see my PCP again to start my 6 month diet and I trust what she tells me I've had her for 15 years now. So thanks to everyone for trying to help me with this. I do feel a little better.

I have Medicare and I did all the tests required by the surgeon before surgery and they sent everything off to Medicare. I was approved 3 weeks before the surgery. I didnt have to have the 6 month supervised diet either. I also only had to attend 3 months of required nutrition classes before surgery. Most insurance companies want 6 months. I started the whole process Oct 23rd 2013 and had RNY Mar 11th 2014.

I have medicare and my bmi is 37 but I have arthris and I'm pre approved. They told me my co payis 1200. MY SURGERY IS TUESDAY. no worries

Good Luck, yes hospital will bill you $1200 for services. Plus Dr.'s fees you have to pay