Medicare/TennCare

Hi everyone. I'm a long time lurker, first time poster on the board. After finally getting up the nerve to "just do it", I contacted a surgeon in Nashville about doing a DS. But... I've hit a wall. I'm on SS disability, and I have Medicare. I also have QMB, which is TennCare picking up what Medicare doesn't pay for. The problem I have is this: Medicare WILL pay for the surgery itself (if I meet the criteria), but the surgeon doesn't take Medicare NOR TennCare assignment for his fees. So, basically I'm left with the surgery being paid for by my insurance, but me having to pay over $8,000 cash to the surgeon. I'll be honest and say that there is no way that I can afford that. I've applied for loans to cover the fees, but I can't even get one because my credit is so messed up. Does anyone know of a surgeon that's close to Nashville who DOES take Medicare or TennCare for his fees? Ya know... I just re-read what I posted and dang if I don't sound like someone that wants something for nothing! I hope no one takes it that way... I honestly don't mean it like that at all. We live on a fixed income though, and it's really just impossible for me to come up with that kind of money. Any help at all is appreciated.

I'm going to reply to myself here. I did call around and find a bariatric surgeon that takes Medicare. After all these days of trying to find someone, I make this post on here, search a little more, and find him! (This place is good luck!!). All I have to do is to get a referral, and I don't think that will be much of a problem. Both my PCP and my neurologist have told me to lose the weight, and BOTH of them put me on meds to do that (The PCP put me on one kind, and the neuro had me change becasue of the potential side effects of the other one.) I've been on them 2 months though, and have gained 4 pounds. My Gastroenterologist and Gynocologist have even told me to lose the weight. But... I see the neuro at 11:30 today, and my PCP at 1:00, and I'm going to ask both of them about referring me. I may be on my way. On my way to dropping some (Most?!) of the meds I have to take to keep my body going. On my way to being rid of co-morbid condistions that can KILL me. On my way to actually being a healthy, active, happy person again!

Hi Tonya, I also have Medicare/Tncare. There is also a Dr. in Franklin, TN a Dr. Oxley. He's really nice. He takes both. Dr. Colquitt in Maryville, a subburb of Knoxville is the one I am seeing for my surgery. When you register with him you pay $200 at that time. Once everything is approved and a date set. you pay $300 at the pre-op testing. He takes both. If you need phone #'s, email me. I have several. Good Luck. Kathy

I know Dr hruska in Clarksville used to, but things change so much. The office staff would know for sure...I have never personally met her, and she does not do the DS either, but she is well loved by all of her patients. Good luck to you! Donna

Thanks for the replies! The doctor I located is Dr. William Richards. He works out of Vanderbilt Hospital in Nashville. The reason I was looking for someone close is that I have a panic disorder, and a car is a huge trigger for me. I don't do well at all on road trips. I know... I'm a big 'ol baby. I admit it. I did see my PCP yesterday, and he's going to give me the referral. The neuro wasn't too receptive to the idea. He's the one that's had me on the Zonegran to lose weight, and I've gained instead. He'd done some bloodwork and was going over the results with me and told me that my growth hormone was low. I had to LOL at him and told him that at 38 years old, I think I've hit my "growth spurt" already anyways and that I didn't want to grow.. I wanted to shrink. I don't think he thought it was funny though. I have to go have more drawn for another blood workup for him. Bleh. Again, thank you so much for the responses and taking the time to answer. If the doctor I located happens to fall through, I'll be looking into the names you posted.

The doctor you're talking about (he's my surgeon) does, or did, take at least one form of TennCare. Is there any way you can change which kind of TennCare you have? Barring that, can you sell your car/house/firstborn? (*grin*) Believe me, having the DS is worth whatever you have to do to make it happen.

Judith: Dr. Richards is your surgeon? He's the one that DOES take Medicare and TennCare. The original surgeon I'd contacted is the one that didn't. I found Dr. Richards after I'd made my first post on here about the other surgeon not taking Medicare. As for selling the car.. the bluebook value is only $500 or so. LOL Selling the house... I rent. And selling my firstborn.... I've tried that. Even offered her for free. No one will take her. (I'm JOKING of course! LOL) Also... if Dr. Richards IS your surgeon, does he do the DS? That's the procedure I'd prefer, but I've only been able to find info about the RNY on the website. I assumed that's the only one that he performed.

Sorry-- I was referring to the DS sorgeon you contacted. So far as I know, the only DS surgeons in Tennessee are at the Cumberland Center for Obesity Surgery, where I had my DS. Again, have you looked into changing which form of TennCare you have? Dr. Husted has been taking at least one of the many TennCare policies out there.

Ahhh, ok. Yeah.. I first contacted Dr. Husted at CCFO. I was told that he doesn't accept Medicare assignment and I'd have to self pay the surgeon fees. I'm on Social Security and am disabled, so Medicare is my primary insurance. The TennCare I have is basically for what Medicare doesn't cover (like co-pays, my deductible, etc.) and I don't really have a choice on that part. If I didn't have the Medicare and ONLY had TennCare, then it wouldn't be a problem to have the fees paid. But with Medicare as my primary... CCFO doesn't accept their payment for the fees. I suppose because it's so low. It's some sort of insurance buracracy deal... since Medicare is my primary, I have to pay the surgeon fees. That's what I was told when I contacted them and spoke to Ellen. I tried to get financing through the group that they use, but I was turned down. My credit really sucks. I'd really rather have the DS, but if I can't, then the RNY was my second choice anyways. Thank you for responding to me!

Bummer! But yes, I'm pretty sure the basic problem is that Medicare pays so very little for WLS---about the same amount they pay for gall bladder removal, a MUCH simplier procedure. (My mom worked for a general surgeon for many, many years.) Good luck to you, whatever happens!