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Back Surgery, and who pays?
I am 65, epilepsy since 22 yrs old, 95% controlled until 2005. Unable to work after a seizure at work, resulting with Medicare and disability money since 2005.
I had a back injury at 22 (not related to epilepsy) rupturing 3 discs (not known to what extent until 50 yrs old), with no med treatment at the time. Degenerative to the extent of non-existent for those 3. Scoliosis further up as a result of 40+ years. For 1.5 years I've been seeing a surgeon who I can plan on having surgery with during the next 1 to 6 months. Surgery will not be avoidable. My need is how to financially manage Medicare-Medicaid-or any other gang.
The cost I'm sure some of you know can clear 200k pretty easy. I had been putting off surgery since 63 believing Medicaid at 65 was going to pay for 99+%. Medicare was at best going to have a 20% copay. After researching even a small amount on Medicaid for my condition (reading stories like mine before walking through the front door of Medicaid or other) it sounds like I should have a better look at how to plan financial damages with too many variables. My fault or not, I don't know where to get good info, or how to avoid a 60k copay or, what happens when you do.
It's not a new diagnosis or a referral to another surgeon that is needed. I'm looking for direction and "warnings" on how to financially manage my possibilities and how to avoid irreversible decisions.
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@1634517678, I'm not sure if you have looked at what is covered by Medicare or Medicare Advantage plans. Here's some information I found that may provide some information and gotchas to watch for.
Is my test, item, or service covered? Surgery: https://www.medicare.gov/coverage/surgery
Medicare - Does Medicare Cover Back Surgery?: https://www.medicare.org/articles/does-medicare-cover-back-surgery/
Medicare Advantage - Does Medicare Cover Back Surgery?: https://www.medicareadvantage.com/coverage/does-medicare-cover-back-surgery
How to Pay For Surgery Costs That Insurance Won't Pay: https://www.verywellhealth.com/how-to-pay-for-surgery-costs-without-insurance-3157020
I would add - if insurance says they cannot/will not pay for certain costs, DO NOT give up! That is exactly what they are hoping you will do! They just hope you say it’s not going to be worth arguing for and go away. Both as a former RN and as a patient, I know this. I literally had to argue for the better part of 9 years for several different procedures and surgeries - all out of “network” because no MD in my network was capable! I seriously thought I might have to remortgage my house. I just kept pointing out their arguments held no water - a jaw joint IS a joint, after all! and said I would appeal to the State Insurance Commissioner if necessary. It was exhausting to do so in the midst of the chronic pain. But I just kept going and each time their review committee would acquiese and finally agree to pay.
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3 ReactionsRe your possible surgery - do you have an Advantage plan too, or just “straight” Medicare? I found that straight Medicare just left me open to potential high copays, seems as if you are surmising the same.
I have A and B. I need to look but I thought Advantage had been presented to me as having A and B.
I don’t think so. Basically with A & B, one covers in-hospital costs, like surgery, nursing care, room rate, meds administered while an inpatient, things like that. The other part pays for office visits, outpatient testing (think bloodwork, XRays, mammograms, colonoscopy, that type of stuff). Medicare D is the medication plan part - some Advantage plans cover it, some you have to buy it separately. Advantage plans basically fill in the gap that Medicare leaves you - that 20% copay type gap. There are many types of Advantage plans. (Kind of confusing if you ask me!)
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1 ReactionThank you John. That's great and certainly 99% more than I had to work with yesterday. Medicare and SSD is all that I have other than a place to live. I've read through some of what you sent and know I might have some questions before making contact with someone. If you are the best mentor to answer those questions, should I do that here, the same as today? Would I need to ask for you?
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1 ReactionYes confusing. I do have D and not expensive. I'll look at Advantage plans. By plans do you mean various companies offering plans or plans offered by Medicare. I'm pretty green on how woven the crew is to each other. 15 years ago having to get SSD with an attorney was quite a surprise.
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1 ReactionHi @1634517678, I'm by no means a Medicare expert. I struggle myself trying to find answers and usually end up calling my Medicare Advantage plan company rep when I have a question about coverage. I think the best be may be to actually give Medicare a call. Here's some info and contact information.
Get Your Medicare Questions Answered - Medicare.gov: https://www.medicare.gov/sites/default/files/2018-07/11386_-medicare-questions-answered.pdf
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1 ReactionI was an RN and I found it all very confusing!
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2 Reactions@migizii I found this information interesting, but it did not include Medicare with supplemental coverage......would you know anything about that?