newbie2001
Super Genius
- 119
Just enrolled a T65 into Plan G. She presently has an ACA plan and was going to get the surgery done with that carrier but is wondering if she could possibly done with Medicare since with the Plan G it will be significantly less.
I called the Plan G carrier they told me yes they would, my upline said it would, the internet says yes/no. My understanding is as long as its considered "medically necessary" then its good to go. But does that mean the PCP sends it to Medicare and Medicare has to check yes or no?
I usually deal with advantage plans so this is new to me. I know Plan G does not need pre-auths but procedures still need to be approved by Medicare? So technically a pre-auth kinda?
I referenced Somarco's post here but its also mixed answers
I called the Plan G carrier they told me yes they would, my upline said it would, the internet says yes/no. My understanding is as long as its considered "medically necessary" then its good to go. But does that mean the PCP sends it to Medicare and Medicare has to check yes or no?
I usually deal with advantage plans so this is new to me. I know Plan G does not need pre-auths but procedures still need to be approved by Medicare? So technically a pre-auth kinda?
I referenced Somarco's post here but its also mixed answers
Does Medicare Cover Strabismus Surgery?
Client has double vision caused by a "loose" eye muscle. Doc recommending strabismus surgery. The condition ("lazy eye") common in children. Less so in adults. In this case it was diagnosed 3 yrs ago (client is 70) and has progressively become worse. Prism glasses provide temporary relief as...
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