Surgeon wants to schedule my TT but medicare doesn't pre approve? Advice needed

Ok Well my Plastic surgeons office called today wanting to schedule my abdominoplasty with anchor cut sides?

My problem is Medicare won't pre approve any surgery . I would have to wait until after to see if they are going to pay.. My question is do you think the surgeon would want to schedule and go ahead with the surgery taking the chance medicare won't pay?

I want so bad to just go ahead and let them schedule and worry about it after.. I don't know what to do.

Last time I went to see him he took all kinds of pictures to submit to my insurance I was waiting for the call but was sure he wouldn't do it if he didn't get approval first!

We also have documentation of rashes and skin break down

Should I just go for it and worry about the price tag later?

LucyB

 I am sure you meet the criteria for the approval.. go for it !  

I'm curious, what is the criteria for approval through Medicare?  I'm not quite far enough out to look into PS yet, but I like to be prepared for the future.   Thanks

 You have to have a certain amt of fat overhanging from your abdomen they measure and its a calculated criteria that you must meet.  I feel if the doc wants to go through with it chances are very good that you meet the guidelines that are recommended.  I had a breast reduction and he wasn't sure if my insurance would cover it  it had to be a certain amt of grams of excised tissue ..  but I made it  they paid for it   whoo hoooo   Good luck in your plastics journey.. its very emotional at least it has been for me.. I have had anchor tt and breast reduction w/ lift  but I need arms legs and face  done  then I will be happy.  Everyone is different.. I now focus on the hanging skin elsewhere instead of being happy w/ what I got.... go figure... Natalie

Dear Lucy:
Your Doctor is right in that Medicare will not pre-certify for any surgery. We must do Medicare surgical cases and hope to get paid. Furthermore, Medicare will never pay for a FULL ABDOMINOPLASTY. Rather, they will pay for a PANNICULECTOMY. The difference is that the Panniculectomy is where we simply amputate the overhanging skin to correct the problem of the skin folds rubbing together causing sores and irritation. This does not include translocation of the umbilicus, tightening of the anterior abdominal wall, or liposuction of the hips. With all due respect to your Doctor, it is virtually impossible to get paid by Medicare for a true abdominoplasty (tummy tuck). I would advise you to be prepared to pay for your abdominoplasty. I wish you the best of luck.

I have to agree with much of what has already been said. Unfortunately Medicare will not pre-approve for medical procedures and they will not cover procedures that are deemed cosmetic (similar to commercial insurance companies). Medicare will cover a panniculectomy if medical indications are documented (rash, ulceration, panniculitis). They will also want to see pictures of your abdomen. An abdominoplasty (tummy tuck) and paniculectomy are very different procedures so I recommend you discussing exactly what procedure you plastic surgeon plans to perform.

Many physicians will have there Medicare patients sign an Advance Benefiary Notice or ABN for procedures. This forms basically states that you agree to pay the fees if they are not covered by Medicare. All this being said, if you have documentation of rashes and skin break down over multiple consecutive visits with one of your physicians not relieved by presciption topicals and your abdomen hangs low enough that it touches your anterior thigh on lateral view, you have an excellent chance of having it covered.

Best of luck with your surgery and congratulations on your great weight loss.

I wouldn't go through with it.  Especially if he's going to do a TT and Anchor Cut.  You will be responsible for the bill.  IF you have the money to pay for it (I'd ask before scheduling what the total cost will be including anesthesia and clinic charges) then go for it, knowing it's very possible you will be paying.

Like others have said, Medicare does not ever pay for a TT and absolutely will not pay for an Anchor Cut regardless of your situation.