Question:
Medicare in Colorado

what do they mean by recertification from Medicare .has anyone had to wait 90 days for Medicare to recertify the hospital and the doctor .this is somewhat confusing to me, I thought that every hospital had to take Medicare no matter what .    — lou1425 (posted on June 15, 2006)

June 15, 2006
Sorry Medicare is not approved till after you have had the surgury. I had mine in February this year and Medicare paid the Hospital Part A no problem. I had to pay my 20% upfront. My surgeon is still waiting to be approved for Part B because for some reason they say there was improper documentation justifying my surgeory. I paid almost all the doctor fee upfront since medicare is really slow to pay. According to a letter I got recently medicare doesn't pay for the Gastric by pass or at least not in Florida. My doctor has appealed twice. If you write me privately I'll tell you something else I found out that might interest you about Medicare.
   — Deborah Joyner

June 15, 2006
Medicare has started a new policy. The hospital has to meet certain requirements in order to be certified to perform gastric bypass and other weightloss surgery. Most hospitals are undergoing this now.
   — Jolly

June 16, 2006

   — nursenut

June 16, 2006
Medicare does not preapprove. The surgeon submits the paperwork on you and does the surgery. Medicare pays cause the surgeon sees your surgery as a medical necessity. If it is medically necessary then medicare will pay. Along with the surgeons office puts the right codes and such on paper when they submit it. It took almost 2 yrs for medicare to pay my surgeon and hospital. They kept sending me bills for the total amount of my gastric bypass RNY until medicare paid them and left me owing them my 20%. They are different I suppose for different states and it is the same way with having plastic surgery. I was told that I had to pay all the expenses and then medicare would pay me back. I called medicare and they told me that if the plastic surgeon put the right codes where they need to be then I would have no problem with medicare paying their part and I would just be left with my 20% to pay. I am still seeking a surgeon further from where I live to do it without me having to pay upfront. Irish
   — mspisces