Medicare and Bariatric Surgery

Due to billing history as they have yet to reimburse for any previous bariatric surgeries; regardless if all criteria has been met and the procedure is considered medically necessary.

The Medicare allowable fee changes roughly every 12 months but is usually around $1,500.00 depending on which surgery you're interested in. For additional information or an exact cost please speak with the office staff and or ask for further information when you have your appointment.

Below is a brief run down about the form from the Medicare website.

Your Protections

If you have Medicare B, your doctor, other health care provider, or supplier may give you a written notice if they think Medicare won’t pay for the items or services you’ll get. This notice is called an “Advance Beneficiary Notice of Non-coverage,” or ABN. The ABN lists the items or services that your doctor or health care provider expects Medicare will not pay for, along with an estimate of the costs for the items and services and the reasons why Medicare may not pay.

What can you do if you get this notice?

On the ABN, you’ll be asked to choose an option box and sign the notice to say that you read and understood it. You must choose one of these options:

Option 1: You want items or services that Medicare may not pay for. Your provider or supplier may ask you to pay for these items or services now, but you also want your provider or supplier to submit a claim to Medicare.

If Medicare denies payment: You’re responsible for paying. However, since a claim was submitted, you can appeal to Medicare.
If Medicare does pay: Your provider or supplier will refund any payments you made (not including your copayments or deductibles).

Option 2: You want items or services that Medicare may not pay for, but you don’t want your provider or supplier to submit a claim to Medicare. You may be asked to pay for the items or services now. Because you asked your provider or supplier not to submit a claim to Medicare, you can’t file an appeal.

Option 3: You don’t want the items or services that Medicare may not pay for, and you aren’t responsible for any payments. A claim isn’t submitted to Medicare, and you can’t file an appeal.

Get details about filing an appeal.

Remember, an ABN isn't an official denial of coverage by Medicare. You have the right to file an appeal if a claim is submitted and Medicare denies payment. Your ABN has clear directions for getting an official decision about payment from Medicare, and for filing an appeal if Medicare won’t pay.