Medicare and Revision questions

Today the patient advocate from my surgeons office told me that Medicare will not pay for revision surgery.  I called Medicare and was told there was no exclusion for revisions.  The patient advocate also told me that, they had gotten a preauth on a previous patient and they still wouldn't pay the claim.  It seems like I can't even get an appoinment with this surgeon now because of it being a revision.  Can anyone help me with this?  Point me in a direction to go.  I feel lost now.
Thank you for reading this and any help would be welcome

Kelley

Medicare paid for my revision and they don't require a preauthorization.  I assume it is like that everywhere since Medicare is a federal program but I might be wrong.  You can give Medicare a call and see if you can talk to someone about it.

Change surgeons! According to his profile here on OH, your surgeon has only done FIVE DSes, which means he does NOT need to be doing any sort of revision to a DS.

Which surgery are you revising from? There are very few surgeons who can do an RNY-to-DS revision, and if you have an RNY, you NEED one of those few. If you're revising from a Band, I suggest you check out Dr. Stewart in Denton, TX.

You can find a list of vetted DS surgeons here: www.dsfacts.com

The patient advocate is full of it---Medicare does not GIVE preauthorizations, period.

Today I have been told by 2 surgeons offices that Medicare will not pay for revision surgery.   Both offices are supposed to call me back with more information when they have it, but right now it looks like no DS for me.  I have had everything done that needed to be done before hand, now they are telling me this.  Why wasn't I told this from the begining? I am very frustrated and very upset.  I feel like my world has come crashing down again.  Last time my world crashed my husband passed away unexpectedly, and left me with 3 teenage sons. Since then I have gained more weight and given up, this was the big step to get a life again.  I guess anything can happen at this point, I am not going to give up, but I really feel beaten at this moment.

thanks for letting me vent,
Kelley

Maybe things are different in Texas.  I have heard of some states having different criteria for Medicare.  Your best bet would be to contact your Medicare administrator directly and find out for sure.

Ive got Medicare and will be having my revision surgery early in 2012.  The people you have spoken with are full of it.  Yes, its true that Medicare will not preauthorize anything anymore (they did away with the entire department that was devoted to performing that duty for a number of years now), so you usually have to sign a paper with the surgeon stating that if Medicare denies payment after the fact...you are responsible for the entire bill.   Have you contacted Medicare to get the scoop from them?  Nevermind, you said you contacted them and they told you there was no exclusion for revision surgery.  Its entirely possible that the people you are speaking with dont deal with Medicare in general (some physicians elect to not deal with it) and are just trying to keep your business with them anyway.  Who knows for sure, but they are wrong in what they are telling you.

Secondly, there is criteria that you have to meet as far as Medicare goes:

1) BMI greater than 35
2) At least one obesity-related comorbidity
3) Medical records documenting previous attempts at weight loss being unsuccessful
4) Surgery has to take place at a designated Center of Excellence facility

I do know that Dr. Rabkin in California doesnt work with Medicare as far as surgery goes, but Dr, Keshishian and a number of other vetted surgeons do.  A number of us have either had revision surgery with Medicare or are going to be having it soon.  You may have to travel to have your surgery done, but it is possible.  Dont let people who are obviously misinformed disuade you from getting what it is you want

I had a "mesh" band placed around my stomach 27 years ago, by a crazy Dr.  (who was later murdered by one of his patients) anyway, I wasn't sure about having Dr. Davis do my DS surgery but I am totally comfortable with him doing it now. Last night my cousin who is a RN and was a surgical RN told me that Dr. Davis is the best surgeon she has ever known. That is a HUGE compliment coming from her.  She was The Nurse admin at THE surgical hospital in Houston for over 20 years and now is the Nurse in charge of training the surgical nurses at Memorial Herman and has just been voted Best Nurse in the Houston and Galveston area this year.  She will be awarded this award on Nov.10th.  So her judgement is crucial to me. 
I did read on this website that he has only done 5 Lap DSs, but that is numbers put in by members of obesityhelp.com, not by the surgeons themselves. 
So on with my saga, I actually have Aetna Medicare and they are the ones who give the approval(preauth) for the surgeries.  I might just have to go with another Dr. Althought I have family in Houston and would feel much better about getting it done by Dr. Davis.  They are supposed to call me back after they look into it further. I am just so frustrated. 

Thanks again,
Kelley

Sorry, but I think you're making a HUGE mistake relying on this woman's judgement. Dr. Davis very well may be the "best surgeon she has even known", but that doesn't mean he's an experienced DS revision surgeon. And no, those numbers come from the surgeon's office, and he's paying to have that profile on here.

It's your funeral.

I guess you haven't read the FINE print on the page of the drs.  but here is what it says

Important Disclaimer - Please Read:

The information on this page is presented solely as a tool for public use and contains information supplied by the owner of this profile. ObesityHelp.com does not monitor or edit this information. The information on this page is presented solely as a tool for public use and contains information supplied by the owner of this profile or the members of this site(so I guess we both were right).
 ObesityHelp.com does not monitor or edit this information.

He has done MANY DS surgeries, The clinical director from Dr Husteds office (her name is Jamie Carr)went to the Davis clinic several years ago. I spoke with her and she agrees that The Davis' are well suited to do the DS.  Jamie was with Dr Husted for almost 20 years.  Dr. Davis also has probably more experience with the prior WLS that I had done than any other surgeon in the WORLD.  He is in Houston were the butcher also was located.  But thank you for the well wishes and the funeral mention.  I do understand about trying to make sure that people look into this and get the best. I feel I have done my homework and I do think Dr. Davis is the best for me.

Kelley

I know Jamie---my surgeon was Dr. Husted's partner when he was located in Nashville.

If Dr. Davis has done MANY DSes, then he needs to update his profile here. He's not on the list of vetted surgeons on DSFacts, either, and if he's qualified, then he needs to be. I don't recall ever seeing one of his patients post here---maybe you should ask him if any of them would be willing to talk to you about their experience.

Believe me, I'm not knocking your surgeon just for the hell of it. We've had posters here DIE because they chose to use an inexperienced surgeon, and some of them were 'virgin' DSers---far less complicated than any revision.

I do sincerely hope that all goes well for you, and that you'll continue to post here and on the DS board about your progress.