Medicare Advantage Plan

I was gonna post this on the Insurance board, but I think I want more local input. I have been Medicare eligible since 1997, just recently however, I switched from my hubbys employers sponsered health plan (United) because they had an exclusion, and I am now covered under my Medicare part A and B. Sept 1st, I am going on a Medicare Advantage plan with Humana,,,,Humana Gold choice. While I know that they will cover the surgery (thats why I switched), I was wondering if I can get any imput from anyone who has had this done thru Medicare. How were they to deal with, and what kind of documentation do they require? Also I have heard that they do not "pre authorize",,,what does that mean? I am assuming that the doctors office has dealt with this before and they will know what is needed to get it paid,,,but I was wondering for myself what Mediare requires. Supervised diet?? psych eval?? that kind of stuff. And also what kind of time frame from consult to surgery can I expect? A side note,,,anyone who has used Dr Villares, or his office,,,what were your pre op requirements....liquid diet?? how long?? bowel cleansing?? And after care,,,liquid diet,,,for how long...that kind of stuff. Also if anyone knows,,,are there any kind of "program fees" associated with this doctor that would be "out of pocket". Sorry to be so longwinded,,,I just have soooo many questions....thanks for reading. Vee

Vee, I have Medicare and had NO problems with it at all. I had a different surgery than you are getting but it is a WLS. I had the Lap-Band in Nov of 04. My surgery was aprox $24,000 and I had to pay $1,500 of that. But that was from the very begining Dr appt on. They did require a BMI of over 40, a 6 month supervised diet with a Dr.( I already had one with my Dr.), I had one appt. for a psych eval (only lasted 1 hour), I also had to go to 2 seminars. one large group one and 1 small group with my surgeon. (That was required from Surgeon not Medicare),I had to see a Nutritionest (sp), My first consult was on June of 04 and surgery was on Nov. but that was not all medicare waiting time. No pre-authorizing for Medicare. I don't have your surgeon and different surgery but I had to be on a clear liquid diet for 10 days before surgery and a week after surgery. Then on to mushy stuff after that. No bowel cleansing for me. but I think the liquid diet did that for me anyway. I was in pre-op for 1 hour, surgery took 45 min. and recovery for 1 hour. Was in the hospital for 1 night only. I had the surgery 8 months ago and am down 70lbs!!! I couldn't be more happy with the decission I made to better myself and my health!! Good luck on your new journey! Terri (Pinedale ,AZ)

Terri Thank you for your input, I am "starving" (pardon the pun) for information, both on my surgeon and on medicare. I am anticipating no problems with medicare, I am just hoping I don't have to wait 6 months on a diet plan that I know is not going to work. The rest of it I can deal with. BTW,,do you have classic medicare, or a medicare advantage plan? I have Humana gold choice advantage plan, as I understand it, they cover whatever mediare covers, but i only have copays, rather then 80/20 and I have prescription coverage. Thanks again Vee

Vee, I have plain old Medicare. I am on disability due to a spinal disease.

Terri I am on disabitlity too,,,degenerative disk disease. I think that is an acceptible comorbidity as well, however with a BMI over 40, actually over 50, I don't know if I need a co morbidity? Vee

Vee, I was just released from the hospital for my Roux en Y done by Dr Villares. He is a wonderful surgeon as well as a very very nice person. He is kind and considerate, and will LISTEN to what you have to say and will answer all your questions. He does strictly laproscopic surgeries and knows what he is doing - I had and have full confidence in him!!! One thing I wish I had asked before is how long it takes for all the gas to get absorbed and released from your body. That's the only painfull part of the surgery that I have found. I still belching and passing gas, but I also have a lot still in me - I only hope that this takes a short time to pass. However. my fibromyaglia has been horrible since but I am able to be back on my on pain drugs for it I also have only Medicare - not even a secondary policy for it. I had to pay $917 on admission, but with Part A - they said the rest should be covered. We shall see. My only complaint has to do with the hospital (Banner Sam) in Phoenix. Not once was I visited by the bariatric staff when I was there and the nursing staff is less than stellar. The LPN's are very good but the RN's pretty much ignore you even when you are out walking around the nurses station. Not a friendly place to be. I did luck out and get a private room (which I had requested at pre-registration) and I was glad because the surgery floor has not yet been remodeled and the rooms are small with 2 people in them. Best of luck on your surgery !!!!

Renee Thank you soooo much for your reply. I like hearing positive comments about my prospective surgeon. Im sorry you had such a yucky time at the hospital,,,is that the only hospital that Villares operates at?? Would be nice to know if I had a choice...lol I hope your bubbles subside soon. That has to be awful. I don't have a secondary either,,,I am using a medicare advantage plan thru Humana,,,According to my plan I have a 165.00 a day hospital copay for the first 5 day,,,then 0 after that. I don't know if the "hospitaization" part of my medicare covers any more of that. I go for my seminar tomorrow,,,I am psyched, the only thing that I am worried about is "hidden fees",,,I noticed Dr. Simpson has a "program fee" that isn't covered by insurance, and you are required to purchase his book as well,,,that kinda sucks, I sure hope Villares doesn't have any of that. BTW,,,what did medicare require from you before surgery? Did you have to do the 6 month diet...psych eval,,,that kind of stuff.. Thanks again for posting Vee