Medicare for an out-of-state surgery
January 4, 2021 12:45 PM   Subscribe

My mother needs a hip replacement in the next year. She lives alone in the midwest, my husband and I live on the east coast. I would like her to get surgery out here so she can live with us for a bit post-op. I am wondering if you have navigated this, particularly the insurance piece with Medicare.

Basically I wonder if there are likely to be any issues with getting a surgeon out here to accept her, getting Medicare to pay for a surgery that isn't local to her, etc.
posted by Bebo to Health & Fitness (4 answers total) 1 user marked this as a favorite
If she has Original Medicare (parts A+B+D) then it should work everywhere. However if she has a Part C (also known as Medicare Advantage) then she will probably have to use their network of providers.
posted by tivalasvegas at 1:09 PM on January 4, 2021 [2 favorites]

You can start with Medicare's online provider directory; I'd suggest calling any provider listed to confirm they currently schedule new patients. You probably also want a provider who "accepts assignment"; providers who do not may require payment upfront.
posted by ThePinkSuperhero at 1:21 PM on January 4, 2021

There are a lot of pieces to consider here. One challenging part to consider is the number of appointments that she'll need both pre- and post-op. She'll need to consult with a surgeon, get x-rays, and basically go through the entire evaluation from scratch if she has it with you guys, which will require a longer stay. There are also educational classes for joint replacement patients, and quarantine requirements now, which may complicate it to say the least. Can she travel for her initial appointment, get whatever imaging she needs, then travel back until she can have the surgery, which would typically have a wait but will likely have a wait that is twice as long with COVID? She's going to have follow-up appoints for at least three or four months after surgery, if not longer. How will she get her prescriptions while she is with you, especially if it is for an extended period of time. Does she have any medical equipment, like a sleep apnea machine, that is hard to travel with? Hip replacements come with a number of adaptive pieces of equipment, like a reacher and shower bench and all else. Will she take those back with her or buy new ones once she gets home? They're not cheap.

You could consider sending the imaging and recommendation to a doctor near you to see if they'll perform the surgery, but I suspect they'll want to perform their own evaluation. You also need to make sure she has coverage through Medicare if she needs to stay in a rehab facility in your area, which is also possible. And the therapy! So much therapy. She would typically qualify for in-home therapy but because your address isn't her permanent address you would need to find out if that affects coverage or her qualification for the services.

Frankly I think the most simple way to do this would be for her to have the surgery where she is and someone in your family goes to stay with her. Really, it likely wouldn't be any longer than a month, but I also understand that life circumstances (like, you know, making money so you can pay your bills) would make that difficult if not impossible. IF you can swing it is the best option hands down. If not, plan for a stay that could end up spanning several months. Flying back and forth for appointments, especially for someone who is likely older, is unsafe during COVID so it would really be best if she just went to you and stayed. But that's not ideal either, of course. And this all assumes that insurance will cover EVERYTHING and you find a doctor who can do the surgery in a reasonable time frame.

Can you find someone out there who will stay with her for a bit? Maybe fly out for a bit then hire help?

I know I didn't clarify everything I brought up but those are all pieces that you need to look into if you're going to do this. Maybe someone else will have a more insightful answer.

Good luck.

P.S. please for the love of god find a surgeon that does the anterior approach. If you don't know what that means, do it anyway. Your future self will thank you later.
posted by Amy93 at 8:22 PM on January 4, 2021 [2 favorites]

Response by poster: Thanks all! Unfortunately I've discovered that she has an Advantage plan, so the plan is moot. Re: flying out to stay with her, my husband and I have two young kids so for many reasons that won't work. My sister has no children and will be flying out for a brief-ish time, but she works in healthcare so can't be working remotely from my moms for any real stretch of time.

All in all it's discouraging -- I was really getting excited about this plan, but I appreciate everyone's thoughts. Off to search for old questions on hip replacement recovery trajectories....
posted by Bebo at 5:28 AM on January 5, 2021

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