Anyone Had This Experience?

Greetings Group! My wife is 3 years out following RNY surgery. Her weight loss following the surgery was very good and she was real pleased. She was 62 at the time of her surgery. The procedure was covered by our HMO and all the bills were promptly paid. Around a month ago, she had an episode of extremely sharp, mid-sternal pain which she had never experienced before. A quick trip to the ER resulted in her being hospitalized in CCU. She spent 5 days there while they conducted just about every cardiac test they had. The end result was, her heart is fine. That was good news. The bad news is, she was still having pain, only now the pain was in the abdominal area. She was discharged from CCU and told to see her Primary Care Physician. The PCP told her she thought the problem might be an abdominal hernia due to the "large amount of weight loss" she had experienced. The PCP told her to contact her Bariatric Surgeon for a followup appointment. The Bariatric Surgeon con cured with the PCP's opinion and that's when she dropped a real "bomb". Since the wife is now over 65, our HMO is secondary provider and Medicare is the primary. The Bariatric Surgeon told the wife, "I don't take Medicare". She contacted her PCP again about getting a re feral to the HMO for coverage and the PCP said, "I will submit it to our in house Surgeons". Well, they all declined to take on an RNY patient and told her to go back to the Bariatric Surgeon. We are still waiting to hear from the PCP on what path she is going to take next. Meantime, the wife is in almost constant pain, has trouble eating and basically, her life is miserable. Sure wish that Bariatric Surgeon had told us up front that she would not take Medicare. Something to think about if your planning to get this surgery.

I would fight the bariatric surgeon on this one. They are responsible for you for 7 years before they can sign off. Check the www.asbs.org page.


Sorry she is going thru this.

Darlene: Thanks for your response. I just sent an E-Mail to ASBS to see what they advise. I sure hope someone comes through and soon. As I type this, the wife is asleep, again, because this pain is wearing her down. My biggest fear is that one of the hernias is going to strangulate and then the HMO will be paying for emergency surgery............hopefully.

I am so sorry for your wife and her pain. I will tell you that the surgeon is willing to see your wife, she just is not willing to accept your insurance as payment-clever huh! This way they are not considered abandoning the patient.
I am also looking to change where I get my follow ups and I am hitting a wall. I have changed insurance and live 400 miles from the surgeon who did the surgery but no one will take me under care. The local bariatrics say I have to go back where I had surgery. This is a problem for me as I move around the country quite a bit. Good Luck

Dear fiftyone52: Thanks for the reply. Yes, you are "right on the money". The doctor did not refuse the treatment, she just refused the method of payment. I'm sure that response made her liability attorney real proud.
I had heard about this type of problem prior to my wife's surgery. I was hoping she would postpone it until I had more of an opportunity to research the situation and try to put "stops" in place to preclude it from happening. Unfortunately, the wife accepted the doctor's assurances that "all would be fine".
I only hope and pray that anyone who is approaching the "Magic Medicare Age" and is considering this type of surgery takes pause and assures that they WILL continue to be seen by the surgeon who performs their surgery. Once the surgery has been performed, it seems that there are a lot of doctor's out there who will choose to "opt out" rather than take on the Bariatric Surgery performed by another surgeon.
Good luck with your situation.

Sorry she going thru this,
I went thru something similiar over a year ago. The bariatric Dr. was not helpfuland wouldnt give me the name of another surgeon to repair my problem. I had to find one that took medicare ,to take care of the problem. Call various bariatric Dr. to find who will take medicare and what the guide line of your HMO are.
Under your problems, most Drs with medicare will take her has a patient.
I know the Drs. that I had did.
Bring all your  medical information in hand to the new Dr.  I hate to say it,but the truth is ,if the Drs. don't take medicare, they will not even touch you. Been there n know from this bad experience.
wishing you well, Go on the boards and look for a new surgeon.

Greetings! Thanks for your response.
I contacted Medicare and the person I spoke to told me that "there are not too many Bariatric Doctors who accept Medicare. He explained that they had strict requirements for the doctor to adhere to and "not too many qualify to be Medicare certified".
I had been told by others who had either gone under this procedure themselves or knew of those who had that this problem that we are having right now was common. "Very few surgeons want to become involved in correcting problems from other surgery." I sure hope they were wrong.
Thanks again.

WHATEVER  STATE  YOU LIVE  FIND A HOSPITAL  WITH  A CENTER OF EXCELLENCE  THAT MEAN THEY  SPECIALIZE IN  BARIATRICS THEY  DO THE SURGERY  AND FOLLOW  YOU FOR THE REST OF  YOUR LIFE ALSO THE NOW ACCEPT  MEDICARE  AND MEDICAID   I LOVE THERE REQUIREMENT  FOR THE SURGERY THEY ARE-REALLY A TEACHING  FACILITY

Not involved in Medicare yet, but I think the docs have to be a Center for Excellence (Pat Root, you might be able to correct me on this).

Hi All! Thanks for your responses. I recently spoke with a person who told me I could pay for the surgery out of my own pocket then just submit the bill to Medicare for payment. I thought this sounded a little strange so I called Medicare for their interpretation. It wasn't so simple when they explained it. The gent said that if the doctor had been a Medicare doctor but then "Opted Out" of being a Medicare Provider, then I would not be reimbursed. If the doctor had never been a Medicare Provider, then the doctor could apply for "certification" and if the doctor was subsequently certified, then they would consider whether or not they would reimburse me.
As for being a "Center of Excellence", this doctor has all types of fancy certificates, as well as the Center of Excellence certification but steadfastly said, "I don't take Medicare". We are still waiting to hear from our HMO's "Surgical Counsel" for the next determination from them. I'll keep you posted.
Thanks again.