Question:
MEDICARE IS MY PRIMARY, MEDICAID OF OHIO IS MY SECONDARY. NEED GUIDELINES ??

I WAS TOLD TODAY AT MY CONSULT THAT I DO NOT NEED APPROVAL FROM MEDICARE BUT,I DO NEED IT FOR MEDICAID. DOES ANYONE KNOW WHAT THE REQUIREMENTS OR GUIDELINES FOR PRE-APPROVAL ARE FOR MEDICAID IN OHIO ?? YOU CAN E-MAIL ME AT [email protected]    — CHERYL M. (posted on August 4, 2003)

August 5, 2003
I have medicre as my primary and a state supplied insurance as my secondary.You do not need preapproval from medicare as they have changed their policy.You just have the surgery and then it gets submitted for approval.If it is found to be medically necessary they will pay their 80% of the bill.The 20% leftover is then submitted to your secondary insurance.Since your secondary is a state funded insurance you do not have to get preapproval from them either.They cannot approve or deny the surgery until your primary insurance medicare,has made their decision.Since medicare doesn't make their decision until the surgery is already over,than it doesn't make any sense for your secondary to approve or deny you before surgery.That is the basis for not getting preapproved from your secondary.They have to wait on medicare.If medicare finds that your surgery was medically necessary then your secondary has to by law,follow their lead and pay the remainder.In the past, you did have to get preapproved through your secondary but not anymore due to medicares policy change.
   — jennifer A.