Medicare and Medicaid
I have a appointment June 28 to try to get help with the 20% Medicare does not pay. I just wanted to know for other people who have been through the process do I wait first for medicaid then file with medicare or file now with Medicare?My Dr told me he would give me a referral when I'm ready, does that go to the bariatric Dr and do they get a hold of Medicare, not sure how to proceed. Any information would be helpful I want to get this started.
Medicare does not pre-approve WLS. There is nothing for your doctor to file with them. AFTER you have surgery, they just send them the bill.
When you have Medicare and Medicaid, Medicare is your primary. The doctor bills Medicare, they pay their part, then they will bill Medicaid for the rest.
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
Medicare (traditional) and Medicaid both require that your surgery be done by a surgeon who is a part of Center of Excellence. Medicare publishes their requirements for procedures, and I am pretty sure that WLS has national rules (rather than different rules for each state) You can look the rules up on Medicare.gov. Your surgeon's office should be very familiar with the requirements for Medicare and Medicaid, if they are a Center of Excellence. If they are not, you will have to pick a different center that is.