New protocol for submitting to IL Medicaid? Surgery before submitting (Xpost)

 Hi everyone,

I talked to the Insurance Specialist at my surgeon's office today, and she said that starting in September that IL Medicaid no longer was pre approving WLS.  She said that their office makes sure you meet the Medicaid requirements, then you have the surgery.  After surgery, they submit your file to get payment from Medicaid.  Has any one heard this???

So now I'm worried (a.k.a. FREAKING OUT!).  Do you think this means that if I meet the requirements then they will pay, or am I gambling that they may or may not cover my surgery?  I've been at this for so long, attending classes, met all of the requirements, etc., but if I don't have a guarantee of payment, I don't think I should have the surgery.  Uggh!  Does any one have any insight?

This is how Medicare works.  They don't pre-approve it.  They have a criteria, and if you meet the criteria, the surgeon operates and then submits the bill and they pay it.  I had no problem getting mine paid for and I've never heard of anyone having trouble getting it paid for.

Now, that's Medicare, not IL Medicaid.  However, if you meet the criteria, I don't see why it should be a problem.  And I assume it's not a frequent problem, or the surgeon wouldn't be doing the surgery and then hoping Medicaid would pay him.  Because you have to know many people on Medicaid couldn't afford to pay the bill if Medicaid didn't pay it.  So the surgeon would end up just not getting paid.  My guess is that you don't need to worry about it.

Kelly

 Wow, that's very interesting.  I had no idea that Medicare worked that way.  So I guess  IL Medicaid is following a similar protocol.

That is exactly what I  thought about people on Medicaid not being able to afford the bill.  Thank you so much for giving me less to worry about.