Question:
My mom is considering WLS and I was wondering if anyone with medicare
can give me some input? How much did they pay? How much out of pocket did you have to pay? Did they approve easily? Wendy open RNY 10/29 — Wendy H. (posted on March 25, 2003)
March 25, 2003
hi..I had medicare and they paid for everything..they also preapprove you
as long as its medically neccasary and it was so I didnt pay for anything
— christine S.
March 25, 2003
Yes MEDICARE will pay for it IF it is medically ness. But MEDICARE is only
going to cover 80% of the cost so if she does not have a secondary
insurance then she will hay to pay 20% I have Medicaid for 2 insurance and
they will pick up the addtional cost left over from what Medicare don't pay
GOOD LUCK my surgery is 3/31/03
— Kimberly M.
March 25, 2003
If your mom has a surgeon who accepts Medicare Assignment, that means the
surgeon accepts whatever amount Medicare pays them and they write off the
balance, so she won't have any amount to pay. Many doctors do this, then
again, many doctors don't too. Shop around.
<p>
Also, Medicare pays 80% of the "Usual & Customary" charges on
any given procedure. Medicare has assigned a dollar amount to every
procedure. No matter what, they will not pay more than that amount for
any of those procedures, no matter what amount somebody bills them for.
Say a doctor charges $100 for an office visit and the "Usual &
Customary" charge for that office visit is only $50. Medicare will
pay 80% of that $50 after the annual deductible has been met. If that
doctor doesn't accept Medicare assigment, you would be responsible for the
remaining 20% of that $50 "Usual & Customary" amount only.
Take care & good luck to your mom :-)
— thumpiez
March 25, 2003
Hi! Medicare doesn't pre approve any longer.You just have the surgery and
then your surgeon submits your info to medicare.They will pay if it's
medically necessary.Some surgeons will have you pay your portion, the 20%
upfront but there are plenty of surgeons who will wait and see what
medicare pays first.
— jennifer A.
March 25, 2003
Hi! Medicare doesn't pre approve any longer.You just have the surgery and
then your surgeon submits your info to medicare.They will pay if it's
medically necessary.Some surgeons will have you pay your portion, the 20%
upfront but there are plenty of surgeons who will wait and see what
medicare pays first.
— jennifer A.
March 25, 2003
Hi! Medicare doesn't pre approve any longer.You just have the surgery and
then your surgeon submits your info to medicare.They will pay if it's
medically necessary.Some surgeons will have you pay your portion, the 20%
upfront but there are plenty of surgeons who will wait and see what
medicare pays first.
— jennifer A.
March 25, 2003
Hi! Medicare doesn't pre approve any longer.You just have the surgery and
then your surgeon submits your info to medicare.They will pay if it's
medically necessary.Some surgeons will have you pay your portion, the 20%
upfront but there are plenty of surgeons who will wait and see what
medicare pays first.
— jennifer A.
March 25, 2003
Hi! Medicare doesn't pre approve any longer.You just have the surgery and
then your surgeon submits your info to medicare.They will pay if it's
medically necessary.Some surgeons will have you pay your portion, the 20%
upfront but there are plenty of surgeons who will wait and see what
medicare pays first.
— jennifer A.
March 25, 2003
WOW! Sorry for the loud hiccup. :)
— jennifer A.
March 25, 2003
the 80/20 rule does not apply if your surgeon and hospital accept medicare
assignment. This means they take only what medicare pays and don't bill
you for the rest. My best friend had only medicare and she did have to pay
nearly 800. for the co-pay at the hospital and 400. co-pay for the doc on
her surgery and they billed her after the surgery. BTW, her surgery cost
30,000. just make sure you use docs and hospital that accepts assignment,
if you do not, THEN you will have to pay the 20%.
— Delores S.
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