Regarding RNY & Medicare process

~~Theresa Marie~~
on 2/3/08 8:30 pm - Closing in on SkinnyVille, VA

This is a copy of a post I made in my local weight loss forum but was told to post here for more information.

I have my second and final meeting with my surgeon on February 12th and they will schedule my pre-op stuff and the surgery. My question is.... Has anyone had this procedure (Laproscopical RNY) done and had Medicare insurance?

With most insurances, the surgeons office have to request pre-authorizations and the insurance companies have to approve the patient so that the procedure will be covered. With Medicare, it is completely and so different. The patient must sign "Advance beneficiary notices" which state that I know that Medicare hasn't decided to pay and if they do not, then I am responsible. I have to sign one for the surgeon and one for the hospital. Then, after the surgery, the surgeons office submits all the info to Medicare and they will make their decision, based on the situation and the Co-morbidities and patients health. I am just curious if anyone on this message board has had to go through this with Medicare and if they'd be willing to share their experience.

Thanks for listening to me babble. I tend to type like I talk. Will be awaiting replies.

Theresa

bonnied
on 2/4/08 11:14 am - St. Albans, VT

RNY on 06/03/05

FYI--I do this for a living at a bariatic surgeon--so this is really true... no doc submits your info to Medicare unless they are audited--they just bill medicare then medicare pays-- if you did your six month consecutive diet and have at least one serious co-morbid condition like diabetes, hypertension or sleep apnea, and had a psych screening---you qualify---- and medicare will pay---don't worry. You have to sign the ABN even to get your blood drawn, it's standard procedure. As long as you meet the stated criteria above, you are fine! Blessings! Bonnie 264/155

~~Theresa Marie~~
on 2/4/08 11:44 am - Closing in on SkinnyVille, VA

RNY on 04/30/08

Thanks so much for writing. I was so worrying that I contacted the surgical coordinator in my surgeons office. She cleared up alot. Medicare is alot stricter, and does require my first visit in the office to be with the doctor not anyone else and because my insurance switched at the end of the year, this would be my first office visit under Medicare. As far as the co-morbidities. I think I have every one of em, lol. Sleep apnea, high blood pressure, diabetes, chf, copd. The list could go on and on. I do feel much better after that talk I had today but I do appreciate you so much for writing. Thanks Hugs Theresa

Regarding RNY & Medicare process

Our Mission

Follow us

Links

Select Photos

Regarding RNY & Medicare process