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In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?

knotreel wrote:In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?

You would think it would be covered as a general aesthetic once is much safer and you would think it would be less expensive because of everything being done while you are asleep all in one go.

Larry

not to mention the cost of the operating room and hospital admissions and rooms

knotreel wrote:... they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered?

Could it just be a billing issue? What if the doctor submits two separate bills to Medicare, one for the AMS 700 procedure and one for the 800? Does Medicare require a waiting period between two procedures? Ask the doctor's billing department, must be a way to do this.

good point. I am wondering if the fact that both of theses operations are revisions to previous surgeries will make a difference. I was surprised and didn't ask many questions when they told me

Just like the stupid rule. You can not have 2 office visits on consecutive days. Have to have one day in between. BUT if you stay in a hospital($$$$$) the doc can come see you every day. Govt + medicare =stipid rules

knotreel wrote:In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?

I have an appointment with Lipshultz soon. What should I expect from him?

knotreel wrote:good point. I am wondering if the fact that both of theses operations are revisions to previous surgeries will make a difference. I was surprised and didn't ask many questions when they told me

I would hope that's not it... the revisions could be because of faulty equipment not lack of skill.

Larry

Baseballfan11 wrote:

knotreel wrote:In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?

I have an appointment with Lipshultz soon. What should I expect from him?

you should expect a good result. I am totally satisfied with his work and hope this "billing" issue can be resolved.