Just got on medicaid, how should we go from here?

Hi, we used to sign on as Jason P. but couldnt remember the stuff to sign on! Anyway, my husband Jason has filed for disability and was just put on medicaid. He has veinous insufficiancy. He has had 2 doctors say that he wouldnt be able to loose weight without the surgery, because of weight/metabolisium(he is about 500lbs at 5' 10"). We dont have documented weight loss plan with a doctor. I was wondering if anyone had any suggestions about what we should do to try to get the surgery. We went to a seminar in Jonesboro and Dr. Jones said in Memphis is the closest to accept medicaid. If he needs to get on plan with doctor, does it have to be someone other then a family doctor? What does he need to do? Even our doctor doesn't know how he is supposed to do a supervised diet to please medicaid.

I do my documented weight loss with my regular Dr. When I see her for my other health problems I also make sure that I talk to her about how my dieting is going and any weightloss I may or may not have had so she will put it down on paper, it counts as weightloss attempts. I may not see her every month but I make sure to see her atleast every 2 months. Did you call and talk to a medicaid person and ask them what the requirements are for surgery? That's what I did when I was doing my paperwork (I have medicare). Your Dr was right about there not being a place in AR right now to have surgery if you are on Medicare/Medicaid. I have been waiting since Feb for surgery. Memphis is the closest and I hear that the Dr's there are very nice.

Hello, I am pre-op gastric bypass, and I have Arkansas Medicaid as well. There is a misconception (some clinics are apparently misinformed as well as prospective patients) about the "center of excellence" thing. I spoke to a representative from Medicaid, and she told me that Medicaid does pay for the surgery if you just have straight Medicaid. It does not have to be done in a center of excellence hospital. The reason people think that is because for *Medicare* to pay, it has to be done in a center of excellence. This includes patients with Medicare & Medicaid, but those patients even have the option of filing with just Medicaid. AR Medicaid will not pay for a surgery in another state, and the clinic in Memphis is in Tennessee. There is a list of requirements which you must meet for Medicaid to pay for the surgery. I will list these at the bottom of this post. From what I understand, Medicaid is very strict in their policies...and one of the rules is that you MUST have been on a one year physician-supervised diet in the last 18 months. It is a must, no exceptions. But maybe you can use physician visits that recorded your weight? There are sometimes loopholes...it never hurts to try. The requirements for gastric bypass surgery for Arkansas Medicaid are as follows: 1.) Psychiatric evaluation.*** 2.) Endocrine workup: AM Serum Cortisol, TSH. 3.) Morbid Obesity Must have existed for no less than 5 years, with complete documentation. Documentation must also indicate evidence that weight reduction was attempted under a physician's supervision for a one year period, during the last 18 months. 4.) T-3, T-4. 5.) Fasting blood sugar. 6.) A recent photograph of the patient. 7.) Patient must be 100 pounds over ideal body weight. 8.) Referral from patient's Primary Care Physician. 9.) Patient must be between 16 and 60 years of age. *** What they are looking for is if the patient has a realistic view of his/her situation, that they are capable of taking care of themselves, that they are self-sufficient and have no underlying psychiatric disease. If you need to speak with someone at Medicaid, the number you should call is 1-800-482-1141. Hope this helps. I look forward to joining you soon on the "losing side". Heather

Complete documentation for morbid obesity? I have high cholesterol and have had it for 4 years. Have had weigh-ins at doctor appointments. I know its not 5 years but are weigh- ins sufficient documentation?

Just wanted to give some encouragement. I have a medicaid spindown and they paid 100% of my surgery. I had it done May 11 of 2005. They are strict but they are very quick in approving it to if you meet the criteria. I mailed my info to my Dr. who is Dr. John W. Baker in Little Rock and 1 week later was approved. So it does pay for the surgery. Good luck and look forward to seeing you on the losing side. Jan