Lap Banding and Medicare

[sharon160 0]

Medicare does not require pre=approval. Once my paperwork was submitted they were ready to do surger;y the next week, even tho it took me longer to get the rv and family ready to travel. Any requirements are from the surgeon (any tests, psychirtist, chest x ray, etc etc)., ;yes, also here, having to stay overnight which I think is a plus, as the nurses keep you on monitors, pain free, walking, heparin shots (so you don't get blood clots).

[sfeiner 2]

I love AARPs plan. I think it's united health. No forms to fill and I never see a bill.

[sharon160 0]

I also have AARP for my secondary. I would highly recommend them. I never see a bill, they pay all excess charges (Plan J) between what medicare approves and what medicare pays. Never a hassle, it's all just seamless.

[maggiehpp 0]

Sharon,

Thanks for the info. I am happy to hear that Medicare does pre-approve, as I would be leery of having the surgery without it. I'm sure your dr. is knowledgable about the overnight stay and medicare, so that's good to know.

I'm wondering if anybody here had surgery at Hurley Bariatric Center in Flint, Mich? It is a COE, and is about an hour from my home. Does anyone know, after having surgery at a COE, can you go to a bariatric center or hospital in your hometown for problems or fills? I hate to think of a middle of the night complication having to drive an hour on icy roads.

Thanks,

markie

[lkgrubb 0]

I had Medicare approve and will hopefully pay for my lapband. (I am sure they have not reviewed bills of yet) I went to a COE in Phoenix. My doctor accepted Medicare, but I was told that the fills where not covered? DOes anyone know this for fact.

Last week 3/3/08 received a letter from the doctor's practice I had used that they were "opting out" of Medicare on 4/1/08 and would no longer bill medicare.

Now my question is this: Does anyone understand the difference between a DOCTOR "opting out" or just not accepting "assignment " of medicare funds. Without Medicare being billed I understand that the supplimental Insurances will not pay. It is all so confusing and I would love it if some really had the real information on this.

[JoannMarie 0]

Hi Karen,

I think my first call would be to the doc's office to find out specifically how this is going to affect you. You have already been banded - they need to tell you exactly what you can do from here. Can you send their bills to Medicare and supplement? Is it possible you can pay for f/u and fills up front and be reimbursed? Do you need to find another Medicare connected facility where you can have the necessary followup care and fills? My guess is this is not an overnight decision on the doc's part, and it is not a very good business practice to leave patients in that situation without some assistance. We're caught in the middle here - Medicare keeps pulling back on what they will pay for our care, while expenses go up for the doctors. I wonder if this is the coming crisis if the country goes for a totally government sponsored health care plan. Your next call should be to Medicare to find out what your rights are and what your next step should be. Start asking lots of questions...

Joann

[lkgrubb 0]

Hi Karen,

I think my first call would be to the doc's office to find out specifically how this is going to affect you. You have already been banded - they need to tell you exactly what you can do from here.

I have done this they say I am covered for their followup care till 4/30/08. But that Medicare does not cover fills

Can you send their bills to Medicare and supplement?

Medicare does not accept any bills except from provider and when a doc opts out they don't even look at the bills from doctor either. ie. from Medicare.

Is it possible you can pay for f/u and fills up front and be reimbursed? Do you need to find another Medicare connected facility where you can have the necessary followup care and fills?

This may be the only recourse for me, and I am looking into it. Since I am nervous about changing doctors this is a tough call.

My guess is this is not an overnight decision on the doc's part, and it is not a very good business practice to leave patients in that situation without some assistance. We're caught in the middle here - Medicare keeps pulling back on what they will pay for our care, while expenses go up for the doctors. I wonder if this is the coming crisis if the country goes for a totally government sponsored health care plan.

This is definitely a crisis facing all people on Medicare, since last summer several practices have closed doors and several doctors have refused to take any more Medicare patients even for routine care. My Primary doctor up and quit her practice because she could long afford to loose money to medicare payments.

Your next call should be to Medicare to find out what your rights are and what your next step should be. Start asking lots of questions...

Monday Morning will see me making that call!

Thanks for your advise and response!

Joann

Karen

[JoannMarie 0]

Karen, I'll be thinking of you tomorrow! Please keep us posted on your situation. I agree we are all at risk. Our ins agent keeps telling us that docs will have to continue to accept Medicare assignment because of the aging population. I don't agree. I've heard too many stories of docs opting out or not accepting new MC patients. It's a worry, but I guess all we can do is keep on keepin' on.

Joann

[sghatl 2]

You can use the following website to check out Centers of Excellence in your area. Medicare will only approve the surgery if it is done at one of these COE's. The list is updated all the time. I know that it takes a long time to get approved as a COE.

Bariatric Surgery

I had my surgery at at COE in December and the hospital's and doctor's bills have yet to be paid. They keep going back and forth with the coding to get it right.

[lkgrubb 0]

I did contact Medicare and found I could submit my own itemized bills to Medicare, I had to wait 3 weeks but did receive forms and instructions on how to do it.

Now the big Question:

HAS anyone had their FILLS paid for by MEDICARE?

Thanks for any information you can supply.

Karen

[sfeiner 2]

Fills are included in the surgical "package" where I go. It's all paid for by medicare and AARP

[lkgrubb 0]

Thanks I will submit fills as I get them!

[norad10 0]

Hi:

I have medicare, and my health plan is senio0r advantage through Hills Physicians-Health Net Insurance Can anyone tell me if they have this coverage and was it approced. Surgeon thought to risky at my age for the bypass, but said lap band would be good. doctor at alta bates does not take health net for lap band. What now?????

Nora

[KD7JUV 0]

I am happy to report that Medicare paid for all but $1024 of my LapBand surgery and my supplemental paid that. The total cost to me was $17 for the TV and phone.

I suggest that anyone who is considering LapBand Surgery and who is eligible for Medicare check with

www. BeLiteWeight .com

JoAnne and the ladies there are great. I have sleep Apnea, Reflux, arthritis, high blood pressure and I was over 100 pounds overweight with a BMI of 40. I had in hand reports from the sleep Apnea Dr. and the Reflux Dr. and my GP all of which supported the need for intervention.

I was all set to go to Mexico, because there was a 2 year wait-list locally. Mexico did not scare me because I know too many people who have gone to Mexico for medical and dental work and have had nothing but good to say about it. BeLiteWeight also makes arrangements for Mexico in Tia Juana and I have met several people sho have gone there and were very happy with the experience.

Then I did one last search on the Internet using Medicare Accepted LapBand and up popped the BeLiteWeight.com site. I made a call and after a quick discussion, filled out their online medical form and faxed all my other paperwork to them and was scheduled for 2 weeks later. My surgery was done by Dr. Gazaerli (his picture is on the BeLiteWeight home page). I was told initially that I would have to pay the $1024, but when I talked to the coordinator at the hospital and gave her my supplemental insurance information, that was the end of that.

My surgery was on April 16th, 2008 at the Detroit Medical Center. So, the only out of pocket expense I had was airfare from Seattle to Detroit and back for my wife and me. We were met at the airport in Detroit and chauffered to the hotel. At the hotel I got a call from the psychiatrist (Dr. K.) who asked me a bunch of questions and was apparently happy with my answers. We spent the night at the hotel and I went in to the hospital the next day. Within hours of waking up, I was walking the halls and actually called into my support group which was meeting for the first time the night of my surgery. I spent the night of my surgery in the hospital and my wife was taken back to the hotel. the next day we were driven back to the hotel and spent the night there. We were taken to the airport by the driver, and that was that. Everything I have described except the flights was paid for as part of the package.

Everyone at the hospital was very professional and very courteous and the hospital was squeeky clean all over. That same day there were a total of 7 BeLiteWeight clients at DMC for surgery.

As for me, I never even took an aspirin. I had no pain at all, except for the gas and that passed naturally ];-}}

For self-pays, the rate at DMC is $11,700.

I asked Dr. Gazaerli when I was in the pre-op area how the DMC was able to do this at that price, and I got an astonishing answer "Because we are here to help people!"

One final comment, what do I do for my fills??? I just had my first fill yesterday. I had to drive 80 miles plus a 30 minute ferry ride each way to a small clinic in Arlington WA where I had the fill. The clinic is run by a nurse who has been banded. The clinic was recommended by BeLiteWeight and charged $125 which I assume is out of pocket. Future fills will be at another support group that meets about 60 miles from home on the 3rd Wednesday on alternate months (the May meeting was too early for the first fill.)

If you have any questions, please feel free to email me at howerton@wavecable.com to call please email me first.

Chuck Howerton in Sequim WA

Edited May 30, 2008 by KD7JUV
misquoote of BeLiteWeight.com URL

[BabsAnn 0]

Can anyone tell me if Medicare pre-approves in North Carolina?

You can e-mail me if u like at Babslong@hotmail.com Thanks

Edited June 20, 2008 by BabsAnn