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Does Medicare have a pre-approval process for surgery?
Mar 3, 2004

My question is whether Medicare has a pre-approval process for surgery. I recently say a plastic surgeon at a large university-based hospital regarding my large buffalo hump. Medicare is my primary insurance. The physician and his staff told me they would have to get Medicare Preapproval for the surgery, and that Medicare might not pay if they determined the surgery was purely cosmetic - the buffalo hump is aggravating an old back injury. After six weeks the physicians staff called me and told me Medicare would not do a pre-approval and I agreed to pay out of pocket. Today I got a bill from the university hospital billing department for the initial visit. However, the initial visit had not been billed to Medicare, and the billing department said they were told this was a comsmetic procedure by my physician one week after my initial visit. When I called Medicare, I was told they never do pre-approvals of any kind. I smell something fishy, but before I start making a real stink I'd like to know if Medicare does or does not have a surgical pre-approval process. My physician would have to accept Medicare payment at their level of payment if he were to bill this to Medicare; I feel like he may be trying to do an end-run around Medicare.

Response from Ms. Franzoi

To my knowledge, Medicare does not have a preapproval process.

Going from large group to small
Employed with no insurance

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