Successfully granted WLS surgery with Medically Needy Cost of Sharing? Anybody?

FLDesignDiva
on 11/20/14 2:56 pm - Kissimmee, FL

I have Medically Needy Cost of Sharing. Has anyone successfully gone through and received the surgery with this type of "insurance"?  My medication I get filled every month puts me over the cost and puts me onto Straight Medicaid, but every month I start back on the Cost of Sharing.  I just wanted to know if it is even possible to do? 

Thank you

Kdiva
on 12/15/14 4:48 am, edited 12/15/14 4:54 am - Margate, FL

Yes I had surgery on 5/28/14 . I can answer any questions you have. 

DS: 5/28/14

HW: 310

SW: 302

CW: 160 ( 1 year post-op) 160 lbs gone

dhorton01
on 12/15/14 10:38 am - sarasota, FL

very good question!  I have insurance provided through my work too, but they do not cover weight loss surgery.  I have recently received the medically needy cost of sharing from Medicaid.  Do you know if they cover the surgery?  If so, where do you find a doctor that accepts Medically needy cost of sharing?

Kdiva
on 12/15/14 10:46 am - Margate, FL

Medicaid definitely covers WLS. Find a surgeon that you're comfortable with ask if they take Medicaid. If not, go to the next surgeon until you find 1. Or you can do a Google search of hospitals in your area & inquire of the Bariatric doctors. Once you meet your share of cost for the month it's straight Medicaid so just ask if they accept Medicaid not share of cost.

DS: 5/28/14

HW: 310

SW: 302

CW: 160 ( 1 year post-op) 160 lbs gone

dhorton01
on 12/15/14 11:07 am - sarasota, FL

Thank you for the information!

Kdiva
on 12/15/14 11:50 am - Margate, FL

If I can help please don't hesitate to ask. When I was pre - op I had many unanswered questions about Medicaid which I had to just navigate as I went. So I'd be glad to assist if I can. ....good luck! 

DS: 5/28/14

HW: 310

SW: 302

CW: 160 ( 1 year post-op) 160 lbs gone

Amanda J.
on 4/14/15 1:26 pm, edited 4/14/15 1:27 pm

I'm going to butt in on this conversation and ask for help. I'm on the medically needy SOC Florida, and I'm in the same boat as someone else, my regular insurance that I pay for won't cover it. Where should I go to? I can't even find a list of surgeons. And how does that work? Does the surgeon bill me or Medicaid? I think that's my main hangup, I don't have a Medicaid number anymore since my post-pregnancy Medicaid is over with, no card or anything. I don't even know where to start at. I've called the surgeon's offices and they say that they don't accept share of cost Medicaid, even some big hospitals that boast taking Medicaid like U of FL Bariatrics. I called the Medicaid office here locally and was told that I had to find a PCP that took Medicaid for them to even start the process of approving a BS. I went to one and he agreed it would be the best route for me, but when I was refused from every surgeon I contacted, I started to get disheartened. Sacred Heart gave me two names and addresses, one in Miami and one in Ocala. Please help. I don't even know where to start or where I should go. I don't mind paying the dr's visits out of pocket or travel expenses, but I simply cannot afford the surgery in cash at this time. 

Kdiva
on 4/14/15 10:54 pm - Margate, FL

What is your share of cost amount?  

DS: 5/28/14

HW: 310

SW: 302

CW: 160 ( 1 year post-op) 160 lbs gone

Amanda J.
on 4/15/15 2:30 am

It's 1338 I believe.

Kdiva
on 4/15/15 3:36 am - Margate, FL

The way share of cost (SOC) works is this: once you have exceeded your SOC for the month you are on straight Medicaid. This is what I did .......I went to the ER with a minor complaint at the beginning of the month . A few days later I got the charges for that visit & faxed it to Medicaid to prove I had met my SOC. After that I was on straight Medicaid for the rest of the month. Here's a plan: Find a Surgeon that accepts straight Medicaid.  Make a appointment with them. If the appointment is May 15 you should go to ER May 1st. That gives you 14 days to get the system updated to your Medicaid.  While at the surgeon as which tests needs to be done for authorization.  Get as many of those tests done as possible that month bcuz it's covered by Medicaid.  Medicaid also requires 6 months of visits with your weigh ins & weight discussed with the Dr.  If you've been under a physician's care & can get those records it counts toward your needed 6 months.  Also most surgeons want you to go to their seminar before you can schedule an appointment. So be sure to do that as well. If you have any more questions I'm here .hope this has helped you

DS: 5/28/14

HW: 310

SW: 302

CW: 160 ( 1 year post-op) 160 lbs gone

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