FRUSTRATED!

[ChronicJam 40]

I have primary coverage through Cigna, with Medicare as my secondary (on disability). I originally was going to have to go through all of the insurance criteria, but because I need to have a previous nissen fundoplication for a hiatal hernia repaired, my doctor was going to be able to do both at once and consider it a revision, bypassing all the insurance requirements. I got my surgery date set at June 30. I did my 2 week pre-op diet, my mom bought a plane ticket to come help with the kids, husband took off work, yada yada yada. Then, last WEDNESDAY, just a few days before my surgery, the surgeon's office called to tell me the surgery center canceled my procedure because they found out I have Medicare.

Um. Did they not do their pre-cert process? Why did they wait until the last freaking minute to tell me? I'm crushed. I know it will still happen, I just have to go the longer bariatric coverage route, but it just sucks. I was completely mentally prepared for it and I feel like I got the rug pulled out from under me. UGH!

[Boise 15]

I am so sorry this happened to you. My surgery was delayed bc they over booked the surgeon on that day. Like you I had mad all necessary arrangements for the family. Mine was only pushed out a week but I understand your frustration. It will happen we just have to stay focused and remember the reason why we are even doing this to begin with.

My fingers are crossed that the process goes quickly!

Good luck

[Saramarie1023 27]

This is a huge deal and I know all the preparations that I went through(emotionally/physically/mentally) and I would be devastated to have experienced that. I am so sorry and hope things go more quickly and smoothly than you expect! Good luck to you!

[Jersrose43 837]

If medicare is your secondary coverage why did they cancel? That's not clear. They'll just pick up the costs of copays and deductibles after Cigna.

[ChronicJam 40]

If medicare is your secondary coverage why did they cancel? That's not clear. They'll just pick up the costs of copays and deductibles after Cigna.

They said it was because they don't accept Medicare at all, so they didn't want me to try and run a claim through afterward. I said I'd sign a waiver or whatever they wanted, but they refused. Medicare doesn't even have bariatric coverage, so it's not like they'd pay anything anyway! I was livid.

[Jersrose43 837]

They said it was because they don't accept Medicare at all, so they didn't want me to try and run a claim through afterward. I said I'd sign a waiver or whatever they wanted, but they refused. Medicare doesn't even have bariatric coverage, so it's not like they'd pay anything anyway! I was livid.

Sounds like bs to me

Medicare does pay for bariatric though I've seen several posts from those 65+ who have had surgery pd for by medicare

Did they offer you a secondary location?

[ChronicJam 40]

Really? I was told they didn't cover bariatrics. Interesting... Yeah, now that I'm going the traditional bariatric route, I can have it done at a hospital, so there shouldn't be any issues. Ha! Right! Fingers crossed, anyway.

[Jersrose43 837]

Well tell the hospital to file any copays you may have to medicare. Can't hurt to pick a little something up for you

[Jersrose43 837]

Here are the regs for you

http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=57&bc=AgAAgAAAAAAA&ncdver=3

[ChronicJam 40]

Here are the regs for you http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=57&bc=AgAAgAAAAAAA&ncdver=3

I looked at that last night, but saw this:

C. Nationally Non-Covered Indications

The following bariatric surgery procedures are non-covered for all Medicare beneficiaries:

Open adjustable gastric banding;

Open and laparoscopic sleeve gastrectomy; and,

Open and laparoscopic vertical banded gastroplasty.