Need help w/ SSI & Medicre info

[Guest guest]

Girls

I have been coresponding with a gal who lives in the same area as I do.

Sharon has had Silicone BI for many years. 3 years ago silicone was lab

Dx as being the substance leaking out of one nipple. She had a Mri last

year to confirm rupture.

Sharon KNOWS she needs these out; That's not the problem. MONEY is. Her

& her husband are both on SSI & have Medicare. They also have a

secondary ins policy; not a name I recognized.

Will anyone, please write me privately so I can get you in touch with

her to tell her how she goes about getting Medicare and/or this

secondary ins to pay for her explant.

Somebody in one of these groups has got to be able to help her. I can go

to the dr appts with her physically, but I know nothing about Medicare.

Thanks,

[Guest guest]

, with SSI a person would be eligible for Medicaid. With SS you have

medicare. And the other insurance would probably be the secondary payor to

medicare. Documentation of medical necessitity will be required for any

SS/SSI or insurance plant to cover surgery....not cosmetic. :Hope you get

the necessary information to help your friend get her need for surgery

documented ...and very soon.

----- Original Message -----

From: <shihtzusrock@...>

< >

Sent: Tuesday, July 09, 2002 1:20 PM

Subject: Need help w/ SSI & Medicre info

> Girls

>

> I have been coresponding with a gal who lives in the same area as I do.

> Sharon has had Silicone BI for many years. 3 years ago silicone was lab

> Dx as being the substance leaking out of one nipple. She had a Mri last

> year to confirm rupture.

> Sharon KNOWS she needs these out; That's not the problem. MONEY is. Her

> & her husband are both on SSI & have Medicare. They also have a

> secondary ins policy; not a name I recognized.

>

> Will anyone, please write me privately so I can get you in touch with

> her to tell her how she goes about getting Medicare and/or this

> secondary ins to pay for her explant.

>

> Somebody in one of these groups has got to be able to help her. I can go

> to the dr appts with her physically, but I know nothing about Medicare.

>

> Thanks,

>

>

>

>

[Guest guest]

, If inpatient medicare works like outpatient medicare, then medicare will not cover explantation surgery. However, if she has a secondary insurance, they should pick up what medicare doesn't. Medicare would need to be billed for a denial, then the secondary insurance billed after medicare denies. The other thing to consider is is this woman's second insurance truly a secondary or a supplemental? Determining which one it is will make a difference in whether they pay. And she will more than likely need to get pre-auth/pre-cert as well as medical necessity documentation. e ----- Original Message ----- From: shihtzusrock@... Sent: Tuesday, July 09, 2002 10:21 AM Subject: Need help w/ SSI & Medicre info GirlsI have been coresponding with a gal who lives in the same area as I do.Sharon has had Silicone BI for many years. 3 years ago silicone was labDx as being the substance leaking out of one nipple. She had a Mri lastyear to confirm rupture.Sharon KNOWS she needs these out; That's not the problem. MONEY is. Her & her husband are both on SSI & have Medicare. They also have asecondary ins policy; not a name I recognized.Will anyone, please write me privately so I can get you in touch withher to tell her how she goes about getting Medicare and/or thissecondary ins to pay for her explant.Somebody in one of these groups has got to be able to help her. I can goto the dr appts with her physically, but I know nothing about Medicare.Thanks,