Hysterectomy/endo/fiboroid surgery and Medicare---HELP

Hello everyone,---------------HELP need QUICK REPLY NOW I AM SCEDULED FOR SURGERY NEXT WEEK!!!!!
I am new to this site and need info. NOW as I am schedulef for a hysterecomy and lap for endo next week. I am on medicare part A and B and have a secondary inusrance private plan not supplemental. I read on the medicare site that these are considereed non-emergency and hysterectomies are not covered etc untles medically necesaary. I am in a panic now. I have no money and am dependin on medicare to pay for my hosptial fees. I have several fibroids in my utersu and one the size of an orange outside it, endo or cyst on one of my ovareis and possiobe endo. I have been on disablity for 3 years and with chronic pain for 3 years from nerve damage but my period for 2 weeks each month leaves me suicidal with the nerve pain worse. My first and second opionons said oh take LUPRON and I said No this is the drug from Hell and my current doc said he would not put anyone on this drug. I am paying for the surgery myself as he is a non medicare doctor, I NEED TO KNOW CAN MEDICARE DENY MY HOSPITAL FEES FOR ANY REASON TO BE COVERED BECAUSE OF THIS SURGERY EVEN IF I AM PAYING HIM MYSELF FROM A LOAN I HAD TO GET. the hosptial told me the OR fees and time will be ajobut $24,000 and $3,000 each day after that. I am in a panic cos I need to get this done in the hope i get my life back and free of pelvic pain due to the premenstrual symtoms where i am out of my mind. Can anuyone tell me for sure if Medicare will not cover my hospital and other fees . they only have private rooms at this place he does surgery and medicare only covers semi- but told me if that is all they have they will cover it. the hosptial said medicare does cover the private rooms as it is all they have and they have a contract with medicare. Medicare willnot tell me any;;thing . If I end up paying ofr the hospital and other stuff it will run into about $40,000 and I have only $5,000 put aside adn no more. HELP should i cancel my surgery cos this cost will have me so stressed and my family cannot support me any;more financially. I am not working cos of my pelvic pain. Does anyone know for sure if they cover hysterectomy and lapororposcy...I need an answer very very soon as I wil have to cancel my surgtery cos of money and financial burden wich i just cannot pay at all. I am so stressed over this I am now on blood pressure tabs. What do I do I have called medicare but they tell me nothing. Will they say No it was not an emergyency or necessary.............I do not know wha tto do but am scared in not having the surgery cos I have had a bad expericie of pain and bleeding that was n ot a period etc but bright red blood just flowing out of me last month after a severe abdoninal pain then it stopeed after 3 days.....................HELP I Need some knowledge on this or anyone who knows for sure would help me know what to do. it s sad to think you need surgery but may not be able to live cos of someone denying you coverage. really scary...HELP :wall:

All I can suggest to you is to get the item numbers they will be using for the surgery and then call medicare, give them the item numbers and ask if they are claimable. I had lap surgery done in the public system in 1999 and didn't pay a cent for it - medicare covered it all. I am having lap surgery done again in a few weeks and going private this time and medicare will cover the gap, but my private cover is 100% for hospital and theatre anyway. Good luck, I hope it all works out for you.

Hi Trillian,
\thanks for the info. (think I have your name wrong here)......I guiess my situation is just not the norm here. I am trying to understand if the first day you are there during surgery etc before you are admitted as in patient is tha billed separatley under part B outpaitent and then inpatient is billed the next day? That would mean i am responsible for 20-% of the oupatient portion contracted rate with medicare.

its so bloody complicated is really makes me nervous completley.....................
thanks again@@@@@@@@@@

Where abouts are you located?

If my guess is correct, and you are talking about US medicare rather than Australian medicare, you won't find much knowledge here unfortunately.

Kmn,
I am in California about an hour from San Francisco.

I'm sorry but we wont be much help to you at all, because we are an Australian site, but you should still be able to get the item numbers and call your insurance company and medicare and find out what to do next :hug:

I'm pretty sure the "item numbers" that Trillian is talking about are for Australian medicare. Are there any local support groups where you might be able to find out more information??
Can your hospital refer you to anyone who could clear up your questions?

sorry to not be more use - Australian medicare is a very different thing

best of luck with your treatment
Kate

I had no idea this was an Australian site.....geez do i feel stupid now........................LOL:redface::doh::wall: :D

Medicare do not tell you anything here at all. They do not preapprove surgery or any coverages until after you have your surgery adn it must be proved that it is medically necessary etc...........what a load of crap honestly.

I have always wanted to go to Australia wished I had gone there instead of here in the USA now. I was a big fan of Heath Ledger and still am even though he is no longer with us sadly. Great Actor adn lovely lovely compassion quiet man. He was so handsome also but a fantastic actor who had so so much potential in his young life. I was deeply upset and saddened by his tragic death......................Australia what a beautiful country.
I will problably never get there but have alwasy wanted to go there!!!!!!!!! ah well not all our dreams do come true I guess athat is just reality. Thanks for all your help girls even though you are so so far away................................
alexandra

Don't know if this is any help, but have you asked your doctor if it will be covered (aside from his fees)? Can he confirm to medicare that the surgery is necessary? Just a suggestion and GOOD LUCK :goodluck: with everything :hug:

Theonly thing is that he knows nothing about Medicare that is why I am paying cash for the surgery he is a non medicare provider.
Medicare said that as long as the surgery is medically necessary it "should" be covered but I told them I am not concerned about the surgery fee as I am paying it, I am concerened that they may not cover the hospital fees because he is a non medicare dr.or if they feel it was not necessary in their eyes.
Can you tell me if in Australia if a non medicare surgeon does surgery on you are your hospital fees/stay covered over there. ia ms ure it is the same over there as here.
Do you know this.? THANKS!!!!!!!
alexandra

Over here there are no non-medicare surgeons. There are some surgeons who you will pay quite a bit extra to in addition to what medicare pays them, but medicare will pay for surgery (with a few exceptions, like some cosmetic procedures). We pay a significant tax (1 to 1.5%) to fund this.
Then there are two hospital systems that run in parallel. The public hospital system is available to everyone, free of charge, but works on a "most urgent comes first" basis - and so people can wait several years for non-life-threatening-but-still-debilitating things to be fixed. The private system treats anyone, and people pay for treatment (either directly to the hospital, or via an insurance policy). The government currently subsidizes the insurance policies.

Like KMN said, we don't have non-medicare surgeons ... recently my bub required surgery, and we paid up-front for the surgeon, the hospital everything (we don't have private health insurance, so we went in as "self funded private patients" so that we could choose the surgeon) and we can now claim a portion of those fees back as a rebate from medicare.
I'm really not sure if or how that works over there?

Hi everyone,
I've suffered with pmdd for 18 years now, and my doctor and I have tried every possible treatment, to no avail.

I'm ready now to get the lupron injections and if they rid me of all of my symptoms, I'll be having a full hysto.

I'm 32 and already have a complete family, and have a strong family history of gyne cancers, so I'm hoping they will approve the treatment/surgery.

BUt my only concern is the cost. Is lupron covered by medicare in NSW?

And can anyone reccomend a good gyne in sydney who understands PMDD and who will take me seriously?
TIA