JoannMarie

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

Hi All, I am really glad to be on this search, because I have certainly learned alot about supplemental insurances. The plan I have states it pays excess physician charges - come to find out they have their own method, and I have been told by the company rep and the agent they figure things a bit differently. I just spoke with a different company got a different story - they DO pay 100% of excess physician charges. I'm beginning to feel I am not getting a straight answer from anyone. I'm waiting for a call back from the COE rep to ask her what their experience is. I'll switch plans - which I am now inclined to do anyway, considering the run-around I'm getting from the current company. It's good to hear the rest of you have had good luck with your Medicare and supplement coverage. I know I'll get there too. I'm just glad to be researching this now before I waste more money on a plan that does not pay what I have been told they pay. Good luck on your journeys! Joann

Thanks, Sharon and Sallie for your responses. Sharon, your weight loss already is amazing! When I read posts like yours I am so encouraged... I should clarify the COE I am talking with was very upfront about their surgeons not being contracted with Medicare, therefore charging their usual charge for this surgery. I know if they are contracted with Medicare they cannot charge you more than Medicare will pay. The center also said (and it is in their written communication) they will accept what Medicare AND MediGAP supplement will pay. I will check that out further and talk to my ins agent about the right kind of supplement. The other COE I am visiting indicated they have 3 surgeons who are contracted with Medicare, so there would be no further charges for the doc. I have been told the Medicare requirements and approvals are easier to obtain than many insurances. The trick is finding a COE with Medicare docs convenient to your home. This will be SO WORTH IT! Stay positive, Joann

I've been interested in this thread because I am also a Medicare patient - kinda mid-point in my research. There are several facilities in my area (Kansas City) that are receiving their certification as Centers of Excellence, but Medicare seems to be pretty slow to get all their paperwork done and billing codes established, etc. Unfortunately, I am not always very patient with crossing the t's and dotting the i's... At any rate, I am considering going to Topeka for my surgery - about 160 miles round trip. My question for Sharon - do you have to go on your 400 mile trip for all your followup, fills, support group, etc, or can you get that done (and covered) locally? I am attending all the local COE seminars in hopes of doing all this locally with a center I am comfortable with. Headed for Topeka this weekend to discuss their program at their seminar. Another thing I am finding -- the docs at some of the COE's do not accept the Medicare assignment. In other words, if Medicare pays $900 and the doc's charge $5000, I would owe the doc $4100. Is this what others are finding? That's out of my league, and would be for many Medicare folks I know. My supplemental ins would help, but I don't know if it would pay enough to make the doc happy. The hospital facilities are accepting the Medicare assignment so that does not seem to be the problem. Ever hopeful, Joann:huh2:

Thanks so much for your replies. I'm happy to hear that good news - maybe I'll be able to hang on! I had heard about the Center of Excellence requirement and am scheduled for an informational seminar at the one closest to me next week. I looked up info on the Medicare/CMS website and it was pretty straightforward as far as whether or not it is covered - written in gov-speak of course, so there was still that concern... I appreciate your information and encouragement. Joann

I am at the beginning stage of researching this surgery - and impressed with how successful and happy most band patients seem to be. I understand Medicare pays for the surgery. How 'bout the fills, follow-ups, etc.? How long does it take for the okie-dokie from the Medicare folks? I am attending the informational seminar at the nearest "Center of Excellence" next week - BUT just can't wait for some answers! Once I decide I'm ready I want to move forward. Sounds like I will have to learn patience again... :smile2:

I am at the researching point in this journey, and anxious to hear ideas and information about the process of lapbanding and the life that follows. In looking at some of the forum topics, it seems there will be a lot of information on this site! Any comments are welcome. Joann:smile: