Question:
HOW LONG DID IT TAKE MEDICARE/MEDICAID TO APPROVE SURGERY?

I WAS TOLD BY MY DOCTOR'S OFFICE YESTERDAY THAT THEY HAVE SENT EVERYTHING IN FOR APPROVAL TO MEDICAID/MEDICARE. HAS ANYONE HAD PROBLEMS WITH THEM APPROVING WLS(ESPECIALLY IN GA)? SHOULD I CALL THEM MYSELF OR JUST LET MY DOCTOR'S OFFICE HANDLE IT. THANKS FOR YOUR HELP.    — PRETTYGRL (posted on October 2, 2003)

October 2, 2003
Medicare and Medicaid are two different things. Medicare is for the eldery and disabled, and does not pre-approve any kind of surgery. Either it is covered or it isn't. Medicaid (welfare), however, will require preapproval for this kind of thing probably. Since your doctor's office already sent everything in, what is it that you plan to do? You need to give it a week or two to let things take their natural course. If you haven't heard anything by two weeks, then call.
   — bethybb

October 2, 2003
IMHO, I don't see any harm in being your own advocate. If your physicians office sent everything in a few days ago, there is no harm in contacting your insurance provider (even if it's medicaid) to ensure they received everything they need to review it. If it's been over a week or two since your physicians office submitted your paperwork then there you would want to contact your insurance provider to see if a decision has been made or if they need additional information. We all know that the squeaky wheel gets the grease! Again, there is NO HARM in being your own advocate and following the process along to ensure it doesn't get stalled out for any reason.
   — Kamy

October 2, 2003
medicare is a federal program and medicaid is a state program. If you have medicare, it is your primary over medicaid. medicare does not preapprove. If it is medical necessary they pay. But medicaid does have to preapprove.Even if it is secondary to medicare and it may take awhile. I have heard they are very slow.
   — Delores S.

October 2, 2003
If you have medicare as a primary and medicaid as a secondary you do not need preapproval from medicaid.You just have the surgery then everything gets submitted to medicare for approval.If they find it to be medically necessary then they will pay their portion.The rest then gets sent to your secondary(medicaid) if medicare pays their portion then medicaid has to follow their lead and pay the rest.
   — jennifer A.

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