Medicare and preauthorization

Options

I am having a 3 day trial for spinal neurostimulation implant for my severe nerve damage pain from my BMX with  node removal.

I called Medicare to see if they will pay. They couldn't tell me. I was instructed to call the clinic.Medicare refused to say if they would cover it and kept telling me to call the clinic. The Medicare representative told me they will decided who will pay for it after the surgery.

The surgery is obviously very expensive and I don't want to be caught in a battle and/or get stuck with the bill.

I called the clinic. They refused to tell me if medicare will pay for it. The clinic representative said she "has heard" that they pay the standard 80%, but refused to tell me if they can get pre-authorization from Medicare.

What can I do so I am not caught in the middle and stuck with the bill?

Has anyone had this problem with regular Medicare (I don't have an HMO or other insurance because I am on disability and they charge so much for the monthly payment, it isn't worth it. People on disability have to pay a higher rate than the elderly who are not disabled for the extra insurance.)

Thanks if anyone can shed some light on this for me.

Cinnamonsmile

Comments

  • Chickadee
    Chickadee Member Posts: 4,467
    edited June 2013

    The medical facility is responsible to obtain pre approval. If the facility doesn't provide documentation as to the appropriateness of the procedure they may have to eat the cost.



    My DH had knee surgery last year. We were told it was pre approved. Well Medicare notified the hospital that they hadn't met the standard for the surgery and Medicare will not pay. The hospital has appealed all year. We got a letter yesterday from Medicare that the latest appeal has been denied and that the patient IS NOT responsible because patient had no reason to believe it wasn't approved.



    Your facility needs to get the pre approval. It's not up to the patient to do that.

Categories