ok so ive gone to see the skin removal surgeon and im not yet at my goal but close to it but when i went to see him he said that medicare doesnt let them know until after the surgery is done if it has been approved or not im just wondering if this has held true to anyone else and what was the outcome??? im not sure if i can take the chance of not knowing and then get a huge bill in the mail later and not be able to afford it!

Totally untrue. Medicare, Medicaid, and private insurance all require pre-authorization for skin removal surgery. They will want medical records proving it's a medical necessity and possibly photos as well.

That surgeon is full of crap. Find a new one that you can actually trust. It sounds like he just wants the money and doesn't care if it's from you or Medicaid.

Well said, Missy.

In Florida our Medicare patients can have anything done and medicare will pay 80 % of what they determined is a reasonable fee.

I have never heard of anyone having to get pre approved with Medicare.

Also Drs have no idea how much of your deductible has been met.

Like I said, that is Florida.

My advice would be to call your Medicare office and ask them.

Good luck!

Actually, I think possibly there may be some confusion about Medicare vs Medicaid.

Medicaid is state run, thus will differ from state to state on their coverage.

Medicare is federally run, thus it's going to be the same base coverage regardless of state. The 80% of covered costs is the same for everyone on Medicare. Now if someone has supplemental insurance, of course their costs would differ, but that would be unrelated to Medicare. It would also vary if they have a state run Medicaid program covering their 20% co-pays.

You actually do have to get pre-approved for some things on Medicare. Like the Lap Band and skin removal, for instance. They have very strict guidelines for tummy skin removal, too. The pannus (skin apron) must fall below the pubis line, there must be documented skin break down for 6 months, and they will not consider back pain as a reason for it. If the skin removal is due to weight loss, you must have lost at least 100 pounds and be at least year post bariatric surgery.

I've actually spoken to them directly about this because I am going through the process right now, too. I am on Medicare for disability. Overall, it's usually at least a 6 month approval process for skin removal when going through Medicare because of all the required documentation.

Just FYI for anyone else on Medicare needing tummy skin removal.

i have no idea about those insurances but this is a great post that can clearly show everyone to always check with your doctor and insurance as they know the answer.

Or you could be a self pay like so many of us and do whatever you like... It's a big chunk of change but so worth it in the long run. Most hospitals have interest free payment plans or you can look into medical credit loans which also are often low interest.

Just curious...how does one yet Medicare before they are 65?

Or you could be a self pay like so many of us and do whatever you like... It's a big chunk of change but so worth it in the long run. Most hospitals have interest free payment plans or you can look into medical credit loans which also are often low interest.

Just curious...how does one yet Medicare before they are 65?

You can be on Medicare if you're on disability- as I am because of having Multiple Sclerosis. At that point it's the identical Medicare as retired people. 80% covered, 20% copays, and we have to pay a monthly premium, too.

...did I mention it kinda sucks, too? *laughs*

I would call them because most insurance companies do not pay for cosmetic surgeries. You would have to have open wounds, pictures and plenty of documentation that this surgery is medically necessary but then its not guarenteed that they will still pay it because it is not life threatening unless of course the sores become infected. Some people have been able to get skin removal and have their insurance companies pay for it but most will not pay for cosmetic surgery.

You can be on Medicare if you're on disability- as I am because of having Multiple Sclerosis. At that point it's the identical Medicare as retired people. 80% covered, 20% copays, and we have to pay a monthly premium, too.

...did I mention it kinda sucks, too? *laughs*

i bet it does....

Well I learned someing new... I had no idea. I do know that it's not Completly free as I had to deal with all of it in my mothers final years....

i bet it does....

Well I learned someing new... I had no idea. I do know that it's not Completly free as I had to deal with all of it in my mothers final years....

Yeah Medicare isn't free. I pay almost $200 a month in premiums on top of my 20% copays. Some people who are lower income get it supplemented with Medicaid so their costs are considerably less. But... I understand fully why retirees are so broke, especially when it comes to prescription drug costs.

sorry guys i havent been on in a few days but i have been reading these through my email... and thanks missy for so much info on the subject i will let this dr know that i need to know if its approved before hand or that i will find a different dr!

You actually do have to get pre-approved for some things on Medicare. Like the Lap Band and skin removal, for instance.

Mis73, This concerns me. I too am on medicare for disability (C5-6 spinal cord injury and tethered cord, among other spine related issues). My surgeon's office told me that medicare does not pre-authorize the lapband procedure and there is no guarantee that Medicare will pay, other than making sure I fit within their requirements. They said they have been on the phone many times and are told no pre-auth required every time they call. I called CMS and verified that my situation meets the requirements, but I didn't ask if they need a pre-auth. . Are you certain they require pre-auth for lapband? I think I better be on the phone with CMS again in the morning.

Also, who is your supplemental plan with? I really need to reduce my costs. My BCBS 20% supplemental plan (covers JUST the 20% that Medicare does not) costs me $380 per month. I don't have any co-pays up front when I go to the doctor, but if Medicare denies something, BCBS won't pay for it either. Interestingly enough, my high deductible plan that I had prior to getting Medicare was about the same price and it covered everything after the deductible was met. Insurance isn't cheap. And as you know, on top of the supplemental plan, it is about $120 per month for Medicare. And my prescription coverage is $45 with ridiculous co-pays. We actually don't have health insurance for my family because we can't afford to pay anything else. And now I'm getting depressed just thinking about money.

[/size]Mis73, This concerns me. I too am on medicare for disability (C5-6 spinal cord injury and tethered cord, among other spine related issues). My surgeon's office told me that medicare does not pre-authorize the lapband procedure and there is no guarantee that Medicare will pay, other than making sure I fit within their requirements. They said they have been on the phone many times and are told no pre-auth required every time they call. I called CMS and verified that my situation meets the requirements, but I didn't ask if they need a pre-auth. . Are you certain they require pre-auth for lapband? I think I better be on the phone with CMS again in the morning.

Also, who is your supplemental plan with? I really need to reduce my costs. My BCBS 20% supplemental plan (covers JUST the 20% that Medicare does not) costs me $380 per month. I don't have any co-pays up front when I go to the doctor, but if Medicare denies something, BCBS won't pay for it either. Interestingly enough, my high deductible plan that I had prior to getting Medicare was about the same price and it covered everything after the deductible was met. Insurance isn't cheap. And as you know, on top of the supplemental plan, it is about $120 per month for Medicare. And my prescription coverage is $45 with ridiculous co-pays. We actually don't have health insurance for my family because we can't afford to pay anything else. And now I'm getting depressed just thinking about money. :wacko:

I actually don't have a supplemental plan right now. Trust me, it's extremely pricey too. But being on a fixed income I just don't have another $300-$400 a month to pay in another premium on top of the Medicare premium.

I called Medicare directly when I was going through my Lap Band. My surgeon did get pre-authorization. I had to have a BMI of at least 40 or 35 with 2 other obesity related co-morbidities. I also had to provide a letter from my primary care doctor saying the band was a medical necessity and why.

I know they still require it for skin removal, but it's possible their requirements have changed in the 2013 calendar year for Lap Band. They have a bad habit of doing that almost yearly it seems. In fact, prior to when I had my band, Medicare required a 3-6 month doctor supervised diet even, but that was dropped not long before I started looking into it so I got lucky and didn't have to do it.

Please do call CMS and verify it directly. I'd even go so far as to ask them to send you their requirements (or lack thereof) either in an email or via USPS. This way, you have proof if something goes wrong.

I actually don't have a supplemental plan right now. Trust me, it's extremely pricey too. But being on a fixed income I just don't have another $300-$400 a month to pay in another premium on top of the Medicare premium.

I called Medicare directly when I was going through my Lap Band. My surgeon did get pre-authorization. I had to have a BMI of at least 40 or 35 with 2 other obesity related co-morbidities. I also had to provide a letter from my primary care doctor saying the band was a medical necessity and why.

I know they still require it for skin removal, but it's possible their requirements have changed in the 2013 calendar year for Lap Band. They have a bad habit of doing that almost yearly it seems. In fact, prior to when I had my band, Medicare required a 3-6 month doctor supervised diet even, but that was dropped not long before I started looking into it so I got lucky and didn't have to do it.

Please do call CMS and verify it directly. I'd even go so far as to ask them to send you their requirements (or lack thereof) either in an email or via USPS. This way, you have proof if something goes wrong.

Yeah, I understand about the $300-400. That is where the $380 I pay comes in. But I have so much medical that it would cost me way more than this if I had to pay the extra 20%. I can never let my supplemental coverage lapse because we would be bankrupt.

Medicare requirements as of a couple of months ago were still what you listed above. My doctor has all of my information together "in case of an audit" so I felt relatively safe until you mentioned that lapband requires pre-authorization. I will definitely call tomorrow just to make sure everything is set to go for my surgery on the 11th. I can't even begin to imagine how I would ever self-pay for this. It would not be happening.

If I were you, I would also get it in writing. Sometimes you can get 10 different answers from 10 different ppl working for the same insurance company.

It just took my daughter two weeks to finally get my granddaughters medication b/c different ppl within ins. co. giving different answers to drug store.