Medicare - NO PREAPROVALS - PLEASE BEAWARE!!!!!!!!!

For those that have Medicare - it has come to my attention this past week that many surgeons tell patients that they are preapproved via Medicare and then when they get the paperwork from Medicare after surgery they get denied.  Dont' get scammed. MEDICARE NEVER PREAPPROVES SURGERY.  They just dont' do that.  It is the same as if you have a to go in forh a gallbladder surgery - your surgeon doesnt' call in ahead of time to get preapproval - you just go in and have the surgery and then you get the papers afterwards to find out that they paid. It is the same thing for WLS - the only difference is you must meet certain requirements or there is no way they will approve you - you must go to a center of excellence - make sure you ask the surgeon or if not sure - check the internet for there website - it will tell you listed in there affiliations.  Then you must have either a BMI of 40 or above - or a BMI of 35 or above and 2 comorbities such as diabetes, heart disease, GERD, asthma, sleep apnea, osteoarthritis - some will consider others.  Then you must have  a psych evaluation, a NUT consultation, medical clearance, - Medicare itself doesnt' require the 6 month diet but some states do.  You must have preop testing and then each surgeon has requirements.

Then, once you have all this done - your PCP writes a letter of medical necessity and all the information and you have your surgery.  All your information is submitted in a packet and you pray you are approved.

So, again anyone who is told you are preapproved - please question your surgeon and tell them that Medicare doesnt' preapprove and ask for something in writing to see what they are talking about.

 i just had rny that was covered by medicare and i had a bmi of 83 and many co morbidites it was a pretty quick approval for surgery 3 nut classes a psych eval and pre op testing and i was on my way oh and the letter from my PCP

what I am trying to say is that straight Medicare DOES NOT PREAPPROVE -unless you have a Medicare HMO or PPO and not straight Mediare with a supplemental where it is paid 80% - 20%, they do not preapprove. I am trying to warn people because I have seen a few post ops get suprised when they get there EOB because they were told that there surgeries were preapproved and that is IMPOSSIBLE - they just don't do it.  So, you may have met all your qualifications and I hope you went to a Center of Excellence with a participating surgeon but you dont' know if they will pay until you get the EOB in the mail.

I would hope that your surgeon had requirements like a sleep study, Echocardiogram, stress test, Endoscopy, Upper GI, and a liquid diet for a month or longer to get your liver to shrink at a BMI that high.

I wish you the best and hope all goes well for you.  I really hope you have no suprised when you get your statement from your insurance company