what exactly does medicare pay for?

calunda · 10-14-2007, 11:55 PM

Okay, I am getting a lap band in Detroit at Harper hospital on the 24th of this month thanks to medicare.

They provide the surgery, a private nurse and a hotel suite for 2 days. A plane ticket comes with them as well, but since we do not have the funds for my hubby to fly does anyone knows if there is any chance that medicare would pay me the $700.00 for ground travel?

I know that that sounds dumb and stupid but I am a disabled veteran and the Fayetteville, Arkansas va hospital gives me $24.00 for "travel pay" to compensate me for gasoline from my Missouri home.

Thanx:clap2:

2bthinagn · 10-15-2007, 01:15 AM

Medicare wouldnt pay my hospital bill saying that with Lap Band the hospital has to be an overnite stay. Didnt make sense to me. Why are you going to Detroit may I ask, several Centers of Excellence in Missouri now??

calunda · 10-15-2007, 03:52 PM

I wondered about going all of the way to Detroit myself. I knew a little about the center of Excellence in Joplin (I think) but did not worry about the Detroit thing. I have been trying to get a lap band for over two years. Either my medicare wasn't excepted, or the Fayetteville Veteran's hospital hasn't gotten the surgery off the ground, or I did not have good credit for a loan, or I got the loan approved and was turned down because the doctor himself wanted for me to make payments over $350.00 a month (to pay off quickly of course).

I am a disabled veteran and would get a lot of pain relief from losing some excess baggage in the tail section. I feel old and tired. At this point, I will ride on a two toed, pregnant yak to zanzibar to get the surgery.

calunda · 10-16-2007, 08:35 AM

There are two centers of excellence in Missouri. One in Jefferson and the other in Kansas City.

In addition, I received a call from one of them informing me that they were opening a new one somewhere here in southwest Missouri within a month or so

2bthinagn · 10-16-2007, 03:18 PM

Actually the website says there are 4 Centers of Excellence in Missouri. Although I believe the Doctor that was doing them in Sedalia no longer does lapbands. The 4 listed are:
Barnes Jewish Hospital, Bothwell Regional Health Center, SSM DePaul Health Center, St. Alexius Hospital

calunda · 10-16-2007, 06:27 PM

With only eight days till my surgery, my hospital told me that I have a co-pay (with my medicare) of $900.00! It seems that a certain company that referred me to the bariatric hospital in Detroit told me more than once that I would have NO copayment. In addition, they never answered my emails or faxes asking for some brochures or books about Harper hospital before I go. They did not even send me any info as to where to report or what time to arrive in Detroit.

I hope that if anyone is going to use their medicare insurance that they ask up front what their copayment is. Remember, you almost always have a copay with them. Dont let anyone use your desperation for the surgery to dupe you into going to a surgery thinking that it is totally free!

Also, please, please be careful of any company that appears to be a "cattle prodder". Someone who procures patients and leaves them to piece out important information as to hospitalization, travel, and hotel fees. It would be easier to look the bariatric hospitals up on the computer and not contact middle person unless it is the facility itself. It seems that they work separately and have different interests. For instance, I know for a fact that Harper bariatric hospital can process all of it's patient's collections of medical records, insurance, presurgery tests, etc.

Last (pardon me for venting), someone at the bariatric referral office called to tell me that she was sending me a copy of a liquid diet that some of us need two weeks prior to the surgery and the brochures and paper work for the hospital. I never received any of those things. I was lucky that my niece was able to tell me what a liquid diet consists of and about vitamins because even though I have been okayed in time I was not told until today eight days away that I am doing the right thing.

phyllser · 10-19-2007, 12:24 AM

Quote:

Originally Posted by 2bthinagn

Medicare wouldnt pay my hospital bill saying that with Lap Band the hospital has to be an overnite stay. Didnt make sense to me. Why are you going to Detroit may I ask, several Centers of Excellence in Missouri now??

Yes, I just looked up all my Medicare claims online today and found that they denied my hospital bill.. $17K, and I'm assuming that it's because I didn't stay overnight! I didn't know that was a requirement, but it seems like my doctor's office and the hospital should have known that! I'm going to appeal it, but not sure I'll get anywhere with that.

2bthinagn · 10-19-2007, 12:37 AM

My hospital supposedly wrote it off. Good Luck. I agree the doctors office should have known this before hand, it wouldnt have been a big deal to stay overnite.

Serena · 10-19-2007, 01:33 AM

The hospital where I went told me that Medicare requires an overnight stay. They were also clear about what my share would be: the $500 program fee and $990 (the usual 20%) because my supplement policy had a WLS exclusion.

Phyl, I think that your program was completely irresponsible for not informing you about this. Do they have a designated person to do all of the insurance coordination? At mine, this staff member was to handle all contact with insurance companies. I had to sign an agreement to pay my share, but the amount would be billed to me after Medicare paid.

Medicare does not pay for fills. My program cost included all services for the first 4 months, but after that, fills are self-pay.

I pay $416 a month for my supplemental policy so I was disappointed that they would not pay for anything related to the surgery.

Serena · 10-19-2007, 01:46 AM

Calunda,

Perhaps there is a better plan for disabled veterans, but in general, Medicare never pays 100%. It sets an amount that they are willing to pay (UCR) which is much lower than physicians normally charge. Medicare recipients are responsible for 20% of the UCR (50% for outpatient mental health or substance abuse treatment).

pitter · 04-01-2008, 09:46 PM

Medicare is paying for your plane ticket? I thought they just paid for the procedure.

phyllser · 04-01-2008, 10:22 PM

Quote:

Originally Posted by Serena

The hospital where I went told me that Medicare requires an overnight stay. They were also clear about what my share would be: the $500 program fee and $990 (the usual 20%) because my supplement policy had a WLS exclusion.

Phyl, I think that your program was completely irresponsible for not informing you about this. Do they have a designated person to do all of the insurance coordination? At mine, this staff member was to handle all contact with insurance companies. I had to sign an agreement to pay my share, but the amount would be billed to me after Medicare paid.

Medicare does not pay for fills. My program cost included all services for the first 4 months, but after that, fills are self-pay.

I pay $416 a month for my supplemental policy so I was disappointed that they would not pay for anything related to the surgery.

It took me a while, but i tracked down what happened and Medicare told me that the hospital coded it to automatically deny. They told me to call the hospital and tell them to resubmit it with the correct code. But when I did that, the hospital told me not to worry about it... they wrote it off and my balance was $0???? Go figure!!!! And I have not been billed for any of my fills or followup appointmnets!??