Question:
Has anyone with Medicare had the surgery and then have Medicare NOT pay for it?

I had my surgery in Oct 2001 (open rny). I have Medicare, which does not preapprove. They have paid for the doctor visits in the hospital, but nothing else. They haven't yet paid the surgeon's fee or the hospital fee. I assumed my surgeon would not do my surgery if he did not think my insurance would cover it. I am on disability and a $45,000 bill would send me into bankruptcy. Does anyone have any info on this?    — [Anonymous] (posted on February 2, 2002)

February 2, 2002
I am not on Medicare, but I spent many years in an office sending claims to Medicare and posting their payments. Medicare probably paid the doctor visits first (easy, clear-cut claims) And could still have the large surgery fees and hospital fees in reveiw. If you are still concerned, you can call the hospital and ask what the status is on your claims. Otherwise I wouldn't worry about it until you get a statement from the hospital or surgeon, and even then, they or you should appeal any non payments. (I think they should. We always did) Good luck!
   — Sandra E.

February 2, 2002
I HAD MY SURGERY ON 11-5-01 AND I ONLY HAD MEDICARE,I AM ALSO ON DISABILITY.MEDICARE PAID MY DR IN ADVANCE ALL BUT $11.00.they have paid the hospital all but $600.I AM FROM TEXAS.my dr handled all the ins. billing i didn't have to do anything.he told me they paid very well.i had lap gastric bypass.i hope they will pay yours i don't see why not. Have they said they wouldn't pay? Some times they pay in payments to the hospital.Maybe they will. good luck.NANCY M. [email protected]
   — NANCY M.

February 2, 2002
I am glad you posted this, because this concerns me also. I have yet to have the surgery, but have heard that medicare only paid a precentage of the actual cost. Some ppl I have noticed had a tiny fee as one of the posters mentioned. Another I know of had a 649.00 feel left that they did not cover. The surgeon I had previously planned to use decided not to nolonger do Medicare patients. That sent me into a tail spin. The one I have decided to use now, may have me sign a document promising to pay if they don't..or so I heard. That really worries me. Please keep us posted many on Medicare look to see how things are handled.
   — TerryS

February 2, 2002
I have my initial consult this Tuesday, Feb. 5, 2002. I have called Medicare 3X re: reimbursement for gastric bypass surgery. I was assured all 3X that they do indeed pay. Good luck. :)
   — katie-mae