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Has anyone on Medicare gone for a second opinion for cataract surgery? Did Medicare pay?
I know I need the surgery but did not like the doctor I saw. He did not explain the procedure well enough for me and was stingy with his answers to my questions. I would like to find a different surgeon, but not sure if Medicare will pay because I am not technically looking for a second opinion; I am looking for a different doctor.
Has anyone on Medicare gone for a second opinion for cataract surgery? Did Medicare pay?
I know I need the surgery but did not like the doctor I saw. He did not explain the procedure well enough for me and was stingy with his answers to my questions. I would like to find a different surgeon, but not sure if Medicare will pay because I am not technically looking for a second opinion; I am looking for a different doctor.
If yours is a medically necessary procedure, Medicare will pay for a second opinion. It won't pay for a third opinion unless the first two opinions differ:
I had cataract surgery on both eyes last January, and Medicare paid for it all. But nine months later, I got a bill for the hospital co-pay, and two office visits, which came to $530. And I was never told about a co-pay, either.
I had cataract surgery on both eyes last January, and Medicare paid for it all. But nine months later, I got a bill for the hospital co-pay, and two office visits, which came to $530. And I was never told about a co-pay, either.
So be prepared.
Thanks for the warning. I have Medigap insurance so I should be ok. You had it in January so you may have been charged because you didn't meet your Medigap deductible yet.
But I still need to know if a "second opinion" will be paid for just because I don't like the doctor. I know it is paid for if you want a second opinion on whether or not the surgery is necessary. Or does the second doctor just submit it as a "second opinion" and Medicare doesn't know the difference.
Medicare won't know the difference. If you're asked why you're getting a second opinion, use a reason other than you didn't like the other doctor. Instead say ..."I just want to be sure this is necessary." No biggee.
I had cataract surgery on both eyes last January, and Medicare paid for it all. But nine months later, I got a bill for the hospital co-pay, and two office visits, which came to $530. And I was never told about a co-pay, either.
Quote:
Originally Posted by moved
I have no plans to pay for anything additional. The $124/month that I pay for Medicare is enough.
Many people feel as you do. And, the Part B premiums are always subject to increase.
That said, Medicare generally only pays 80%. In addition, should you ever be hospitalized, Part A (hospital) has a $1,316 deductible before it pays; and all Part B expenses (docs, labs, etc.) have a 20% copay whether in or out of the hospital - plus Part B has a $183 deductible to be satisfied before Medicare pays its 80%.
No one as they age should rely only on Parts A&B. Sooner or later, that 20% and hospital deductible will become a problem. Hospitals and docs are pretty ruthless these days about using collection agencies, etc. If you don't mind the ding to your credit. Then, there is always the wage garnishment route. So, not planning to pay, at least for me, is not a realistic strategy long-term.
Since you are in California, you might want to consider leaving Original Medicare and enrolling in a Kaiser Advantage plan which generally does a good job in certain areas of CA. There are some copays attached to Advantage although, for the most, there is no premium. And, the plan has drug coverage. One California poster uses Kaiser in the LA area and is very satisfied.
We have another poster here whose income is low enough for Medi-Cal. You still work, as I recall, so may not fit that criteria, yet. But that's another consideration.
I used to have Medi-Cal (Medi-Medi), but always made too much money for Medi-Cal, even with just working part-time. Also, having it is a PITA, because every month I had to bring in proof of income. Then, when my income went over the limit, my Medicare would get cut, because they took out the payments. So I decided that I would rather work than deal with them anymore.
I can't stand Kaiser, and there none close to me. I had them at one time, and got rid of them very quickly, too. I get all of my dental work done in Mexico, and can find a doctor over there too, if needed.
Just go for an appointment. Don't say you're seeking a second opinion, that usually scares the second doctor off. Few doctors will actually second-guess one of their own. Right now, you don't have any evidence of other intervention, no actual procedures done, so another doctor would be none the wiser.
I will probably get a lot of flames about this, but I'm just telling you how it is, not how a "perfect world" works. When you go between doctors you get into all sorts of innuendos, most of which have to do with the doctors' relationships with each other, not what's necessarily best for the patient.
Try to make sure the new ophthalmologist is not somehow connected to the first one. Even if not in the same physical location, they often are connected via LLP, etc. Especially ophthalmology--the equipment is so expensive they often form alliances, business partnerships, etc, to share the costs. You could find yourself going to a second doctor only to have your records from the first doctor pop up.
I doubt Medicare will question why you're seeing another ophthalmologist, just make sure the second doctor accepts Medicare.
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