Question:
HAS ANYONE HAD ANY PROBLEMS WITH MEDICARE PART A?

I ALREADY WENT TO THE CONSULT. AND DID ALL THE NUTR., PSYCH, BLOODWORK, EKG, AND ALL I NEEDED WAS A LETTER FROM A PSYCH OR MY PCP BECAUSE OF THE ZOLOFT I TAKE . I GOT THAT LETTER ALREADY MY PCP WROTE I CAN GO AHEAD WITH THE SURGERY, WHICH I ALREADY FAXED OVER THE LETTER 8-17-06 SO WHAT HAPPENS NEXT? AND I HAVE MEDICARE PART A HAS ANYBODY HAD ANY PROBLEMS WITH THEM? DEBBIE    — DEBBIE C. (posted on August 19, 2006)

August 19, 2006
Hi Debbie: Medicare Part A isn't going to be the problem it's Medicare Part B. Part A will cost you 952 for the entire hospital stay and the procedure itself being done. Part B is the doctor fee. Well I had the procedure in February paid over 1/2 of the doctor fee up front from what Medicare told me they pay $1750 of a $4200 fee which leaves you paying about little over $300. Medicare denied my part B claim and now it's being appealed from what I understand it's pretty standard with them. I'm suppose to be getting back over $1000.00 when it's finally finished. You realise you don't have to be prior approved by medicare they don't do that. Only PPO and HMO's are the ones who do that. Now if your in one of those Medicare Advantage Plans that works like a PPO and you will need prior approval. But basically they pay just like Medicare. Good luck!
   — Deborah Joyner

August 20, 2006
I have medicare part A and B. They do not pre-approve. Your doctor has to say that the surgery is medically necessary and they will pay when the doctor sends in what he is suppose to with the right codes and whatever. You having only Part A medicare you will have to pay the allowed fee of $976 which I had/still have to pay. I also was responsible for my 20% of the doctors fees they charged. I was or is still out of over $1100. I did not have to pay the $976 up front though. The hospital billed me 2 weeks after I had surgery. My doctor had me do a whole lot of tests before wls and I did not have to have no letters or supervised diets from my pcp. I was on Buspar when I went for my psyche exam and in explaining to him my having the Rheumatoid arthritis and having the anxiety attacks and not sleeping was the reason for the med. I had no problems with medicare paying anything and but just me having to pay what I had to is difficult. Being on disability finances are very limited for me. I wish you luck. But call medicare and see what they say.
   — mspisces