Question:
Need to find physicians that accept Medicare and do revisions, can anyone help?

I have a physician who when I started accepted Medicare and does revisions. I meet all of Medicare's guidelines for revisions, but was told today by doctor's office that hospital is now requiring all Medicare revisions to be done as self-pay paid in full before the surgery can be done. She stated that the hospital made this decision because they are not getting reimbursed by Medicare in over a year and she doesn't know it is a coding issue or what. I spoke with someone at Medicare and they confirmed I met all the criteria and it is a covered benefit. He stated he doesn't know why the hospital is not being paid if the people met the criteria and suggested it might be a coding issue. He also suggested I find another physican and facility and switch to them. I don't really want to do this, but will if there is not any other way. The doctor's office is supposed to be talking with the hospital some more next week in regards to this matter. Meanwhile, I want to explore my options. According to this website, I have found 3 that does revisions and accepts Medicare, they are Jeffrey Lord, John Nye, and Jeffrey Friedman. Does anyone know of any doctor that maybe able to help me? Thanks! southerngeorgiagirl    — southerngeorgiagirl (posted on May 29, 2009)

May 30, 2009
I'm not sure about the doctors, but if you aren't doing this already, make sure that the hospital is designated as a Center of Excellence for Bariatric Surgery by the American Bariatric and Metabolic Surgery Society. People who have Medicare and state Medicaid insurance are required to go to COE hospitals, and to use doctors with the ABMSA certification.
   — [Deactivated Member]

May 30, 2009
Thanks Corrie, the 3 doctors I mentioned are associated with eligible facilities, I just have to verify with their office that they will accept Medicare and does revisions. This site says they do revisions and Medicare.gov says they accept Medicare, just have to verify that this is true and choose one to go to a consult with. Thanks again.
   — southerngeorgiagirl

May 30, 2009
I am glad you posted this. I was told by medicare that they would or do cover plastics as well, but certain coding issues the drs make is what keeps you from getting what you need done. I was told that I would have to pay up front for my panni removal and medicare pay me back. Medicare said the drs all they had to do was use the code that medicare gave me and they would get paid, but it would take some time. I have been so depressed over this the last 3 yrs and gave up on losing anymore and gained back 50 plus lbs. This last 2 mos I started trying to lose to take the stress off my back. I have Rheumatoid arthritis and the meds make losing so difficult. But I am glad that you posted this cause I am facing possibly another surgery to fix an enlarged stoma and was going to consider not having it done if medicare would not pay. My surgeon does the revision surgery, but I have only read in his newest patient info that he does revisions. I live in Alabama.
   — mspisces

April 18, 2010
I know as a fact that Loma Linda Hospital, in Lima Linda, CA does do the panni removal on Medicare. Please don't give up, it took me over a year to find Doctors who would do this on Medi/Medi. It is the next step after drastic weight loss. Good Luck!
   — deborahvillalvazo