Question:
Anyone been denied by Medicare for RNY

I am on Medicare and with that said, they want three yrs of documented efforts on losing weight by taking diet meds, I said there is not a doctor out there that would give me, with diabetes and highblood pressure, sleep apnea to have me on diet medication, so I got a call about a month ago, I was told I was approved, thinking by Medicare, I then had a question and someone from the Bariactric office, said I was approved by their dept, and that I would have the surgery, an then my claim will be sent to Medicare, now isn't that alittle backwards? Is there anyone out there waiting for approval by Medicare? Appreciate any feedback. gail    — wopah7 (posted on November 1, 2005)

October 31, 2005
Hi Gail, I had surgery on 8/23/05 and I am also on medicare--"Thank God". Now my understanding of this payment thing (I may be wrong), is that Medicare will pay 80% of your bills, just like regular insurance and you are responsible for the other 20%. I was fortunate to also have Medicaid, which took care of the other 20%. How I know that we are responsible for the other 20% is two days before my surgery I received a call from the Insurance person at my Dr's office stating I owed this amount of money before the procedure could be done. After I stated that I also was on Medicaid also her tone changed and she said "Oh, I didn't have that in your records, don't worry about anything then." And I haven't heard anything else about this and when I received my statements from Medicare everything was "Paid In Full".
   — mischief85

October 31, 2005
I too, am on Medicare from S.S. disability. I was told that because it was SSD and not SSI, I was a shoe in for the surgery. It took one week from the time the paper work was submitted to be approved. Don't give up. Stay in contact with the doctors office. Good luck and God bless. RNY Lap 6/16/05 292/198
   — LilaDove

November 1, 2005
Medicare will not pre-approve anything. Your doctor may submit paperwork but Medicare doesn't work like that. Medicare will pay for anything that is medically necessary. You will have documentation of your diabetes and other obesity related illnesses in case medicare denies your claim then you will need to file an appeal to medicare. Hope this helps you and also you can call 1-800-MEDICARE to verify this information. Best of luck.
   — Irislady

November 1, 2005
Hi Gail...I too have Medicare (entitlement from kidney failure) and I am almost two months out from my open RNY. I didn't have any problems getting approved through Medicare. They are my secondary insurance but they were the only one that would cover it. They covered 80% of 25 grand which is a good chunk. I was told the only requirement needed for Medicare to approve was to have co-morbidities (such as hypertension, diabetes or like the sleep apnea). You should not be experiencing these kind of difficulties! I would contact Medicare directly and ask what their qualification process is for this surgery. Good luck dear!
   — Pamela B.

November 1, 2005
Gail, I also have medicare and they told me I would have to have surgery first and then medicare would approve. i was worried too because if they didn't pay, I didn't have that kind of money. I am also on Keystone Mercy (medicare), and they picked up what they other didn't pay for. I was in for 8 days (I have a clotting disorder and it extended my stay) and I didn't have to pay for anything but the nutrition appt. Good luck and keep the faith. My co-morbs were sleep apnea and high blood pressure. Lisa Hackenburg lap/rny 10-23-03 340/170/??? -170lbs
   — Lisa H.