Insurance coverage for surery

[yeddi18]

I just got medicaid here in Ohio through Caresource, which is the company that manages the plan.  I asked them if gynemastia surgery was covered for any reason and they said it is.  They need my chart from my doctor.  I have an appointment with him next week.  What should I say to him?  I am overweight 5'9" 250.  I have lost 40 lbs.  I drink moderately.

[hammer]

The truth is usually the best to start with!

Not sure, what else your looking for?

[yeddi18]

Not sure what you mean by "the truth".  The truth is I want the surgery.  Is that all I have to say?

[hammer]

You asked "what should a say to him"? I don't understand why you need to question what you need to say to your doctor about wanting to have gyne surgery?

Tell him your want to get the surgery! What else would want to say? That you want to get a new go cart, or that your going to need a physical to take up horse back riding?

So I said that you start with the truth, you said the truth is that you want the surgery, sooo, that is what you say to him, "doctor, I want to have gynecomastia surgery"! If this will be covered as you said you may or may not need a referral, but be sure that the doctor doing the surgery has this type of experience or you may be very unhappy with the outcome.

[MammaryMan]

Would it be safe to say that most plastic surgeons would rather not fight it out with Medicaid and/or Medicare to cover the cost of the surgery because the disbursement is so low as to make it not worth the effort? I'm afraid, that at the current rate of declining Medicare payments, there won't be many top tier surgeons willing to work on Medicare patients. And who could blame them?

[hammer]

Do you know what to means to assume? It makes an an ass out of u & me! (Ass, u, me)

The best thing for you to do is to research the doctors in your area, or if your willing to travel, the doctors in  the areas that your willing to go to. Find out if they do take Medicare, Medicaid, then go from there. Once you have the list of which doctors that accept those payment you can pick the one your most comfortable with.

[MammaryMan]

Mr hammer, you must not have read my post very carefully. I did not assume anything. I posed a question about Medicare disbursements. Note that a doctor accepting Medicare payments is not the same as having the doctor convince Medicare to provide prior authorization, which is almost always required in the case of procedures supplied by a plastic surgeon. This can be a lengthy and tedious process for the doctor and his staff. Some of the top prostate oncologists have opted out of Medicare because getting new treatments approved by Medicare is too difficult.

[hammer]

I have never had this surgery, however, prior to taking my medical care to the VA I was using my Medicare for all my surgeries, but the last back surgery done this last Dec at the VA.  I've never had to wait to have them done! The VA doesn't charge Medicare, because it would be the government paying the government.

These were major surgeries, both knees replaced, and back surgeries, so that may have made a difference, but as I said, never needed to wait once it was decided the surgery was needed. I've had some minor, same day surgeries as well that have been covered.

I've never ran into the problem of doctors not excepting Medicare or having any delays.

On the other hand, you do not have a life threatening  problem that you need to rush to have the surgery, so you can wait to have the approval for the payment. I say it isn't life threatening because I've had it all my life too and have grow to Double "Ds". I've learn to live with them because of all the other health issues.

If you can get the surgery payed for and save $3,000.00 plus is it worth the wait for approval? That is also a very low ball starting figure!

The first step is looking for the doctor that accepts Medicare, you won't know if this will work out at all until you first pick up the phone, so I would encourage you it is time to grab the phone!

Good luck!


Bob