Question:
I have Medicare. I called last week to set up an appointment with a plastic surgeon

I have Medicare. I called last week to set up an appointment with a plastic surgeon for a tummy tuck and breast reduction. His sec. told me that Medicare is "no longer paying for ANY abdominal plastic surgery in this area." What's up with this??? I thought Medicare was easing up on it's limitations for plastics after RNY, NOT TIGHTENING up! I live in Virginia. Anyone know anything about this, or any alternatives I have? I have Tricare as a secondary insurance, but the sec said that Tricare will deny if Medicare doesn't approve. Thanks.    — Linda S. (posted on August 21, 2004)

August 22, 2004
Every surgeon's office I have called (five or six) turned off immediately when I said "Medicare"; mainly they told me that it is impossible to get them to approve the surgery. One did offer to do breast reduction. I am a veteran and am now trying going through the Veterans Administration hospital system. It takes forever to get an appointment at a clinic to get an appointment with a surgeon (that sounds funny, but it's true), but it is worth the wait. What else can I do? Nina in Maine
   — [Deactivated Member]

August 22, 2004
I do not know anything about plastic surgery coverage, but I am on Medicare also and my secondary is with Guardian. I had some other medical bills, blood tests and chiropractor that Medicare denied. I called Guardian and they said they would probably deny them too as they go by Medicare guidelines. I didn't think this was right so they have to go by their own contract benefits and these items were covered under my policy and I had used Guardian PPO contracted providers. I submitted the bill along with my Medicare EOBs and Guardian did pay. I believe you should get an estimate and pictures and such and submit to Tricare for preapproval, it's surely worth a try. Please let me know the outcome and I will be trying to get this done soon also.
   — Carolyn B.

August 22, 2004
I'm a little suprized by your post and your answers thus far. I just had a Fully Tummy tuck (anchor incision) with lots of muscle tightening-13 days ago- Medicare paid with NO PROBLEM- They also approved me for a breast lift- but I chickened out of that about an hour before surgery- What you might want to do is contact your surgeon that did your WLS, and ask them to give you a refferal to a surgeon that will accept Medicare- That's what I did.
   — WABBIT F.

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