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01-07-2006 09:42 PM

Medicare supposedly will pay for the ADR surgery although it seems that the hospitlas are not booking the surgeries because Medicare is not paying enough to the hospitlas. The doctors seem willing to cut their fees, but the problems seem to be that Medicare is not reimbursing enough for the cost of the disc. Medicare patients are not allowed to pay any difference in the bills and the hospitals, and doctors are not allowed to bill the patient the difference.

Medicare does pay for surgery overseas in an emergency. I wonder if Medicare would pay for an emergency ADR overseas and if the hospitals there would accept the surgery, and if not if Medicare patients could pay the difference to the doctors and hospital over there.

Any thoughts? Thanks!

luvmysibe 01-07-2006 11:46 PM

Best wishes and good luck! I would be completely and pleasantly surprised if Medicare paid for any portion of an out of the country procedure. Maybe there is more flexibility with medicare than WC, although highly unlikely.

01-08-2006 03:12 AM


why do you sound so confident that Medicare will pay for ADR? All I know is that they are presently considering and reviewing a proposal for a national ban on covering ADR. I'm not aware of a decision yet. Locally the policy may vary until a national policy is made.

re, overseas, i guess for now it might also vary depending on the local administrator used for medicare benefits.

i don't know anything specific but your post almost made it seem like you might know different and would love to hear what you now to benefit us all!

Mariaa 01-08-2006 09:32 AM

No, I don't believe Medicare will pay for this surgery unless it's an emergent situation while one is abroad. I might be wrong but I would tread lightly here with regard to hopefulness on this because I think if Medicare pays for ADR, it would be Charite implant as it's been FDA approved for one level so that might be it, but most likely here in the states.
I know it won't pay for ADR surgery for me as I had to sign a waiver type of form regarding my low back coverage with Medicare as the injury was WC related and is covered by Lifetime Future Medical Benefits with WC.
My husband just got BCBS of MA. so I am dropping my AARP coverage and have switched to BCBS but they also won't cover anything to do with my low back as it's covered by WC... (I'm screwed)...
**** If you find out differently in your own particular case, please let post!!! Would be a good precedent for others with Medicare wanting to go abroad (which is where I'd really prefer to go for this surgery tho that won't happen with my WC insurance).

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