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

So I have to go to the er every month For like 6-8 months? I mean I understand it just seems extreme. :) I don't mind paying out of pocket for the visits, can I just visit the er before I have to have blood work or tests?

If you schedule all your appointments for the same month you're covered. Things needed for approval are: clearance from heart dr,  psyche exam & clearance, endoscopy, nutritional visit, 6 months pcp visit & letter of medical necessity.  if you're not covered by insurance it can be very expensive.  So it's up to you what you do. Have you been to a doctor lately? 

I have a PCP that I normally go and see, I have not been to see him since December though. He is not Medicaid approved or covered, although I have been under his medical supervision dieting with phentermine for over 2 years now. I was advised by the Medicaid office locally that if I wanted to pursue the weight loss surgery I would have to start by getting a Medicaid approved PCP. I went to see one one time back in June or July of last year and he agreed it would be the best route for me, but I did not go back after I was turned away from all the surgeons offices. I have documentation that I have been dieting and using phentermine for over 2 years now, but it's coming from a non Medicaid source so I don't think they will take it.

Your pcp don't have to be a Medicaid doctor. As far as your dieting history get copies of those records. Being that you haven't seen the Dr since Dec they won't count as 6 months visit.  They have to be 6 months consecutively.  If you was still seeing that Dr it would count. Question: the pcp that is supportive of you having surgery can you see him/her for 6 months back to back? If so start now. ...all Medicaid needs from your surgeon is the Dr notes. ....showing 6 visits of weigh ins & discussion of weight loss attempts & also a letter of medical necessity. Start with the surgeon now as well so at the end of your 6 months you should have all tests done & only waiting on the 6 months visit to submit for approval. But your pcp don't have to be a Dr that takes Medicaid bcuz you're be approved through the surgeon that accepts it

I'll just go through the Medicaid doctor being that I have to start over anyway. He told me to gather what he needed to do and he would do it. Should I just contact the surgeon I'm interested in and ask them what he needs to do? I think UofFL had some stuff online for the doctors involved. The Medicaid doctor I was seeing had not done it so I believe I'm going to have to navigate the lining up of stuff myself. Will the surgeon have a list for me/him?

Yes contact the surgeon you're interested in. Go to a seminar & there they will give you everything you need to get approval. Also be sure to talk with the insurance coordinator who is usually at the seminar to get precise information as it relates to your coverage which is straight Medicaid.  Do not say you have SOC bcuz most ppl don't know the way it works. Who are you thinking of going to? Which procedure? 

Hello Kdiva:

I am trying to get my bariatric surgery thru SOC. I understood everything you explained before, but I would like to know if the expenses of the ER visit were payed by Medicaid too, or you never received any reimbursement for this expenses?

Another doubt that I have is: What kind of medically expenses are allowed to activate the Straight Medicaid? I just have to run thru ER and that's it?

The Doctor office told me that they accept SOC Medicaid but they told me that is really hard, because I have to spend each month my SOC amount which it is 1,200 until I got the approval, so it is really risky.

What do you recommend me to do. I am desperate, my back is killing me, I am so sad all the time, I can even put my sneakers properly, I feel like I am jailed in the body of someone else. But is really hard to get information about this kind of surgery and cover.

Thank yo so much for share your experience. In all my Internet Research your post are the only clear information that I found. 

God blessed you!

To answer your questions:

1. My visit to the ER was totally paid for through Medicaid.  I only saw the bill bcuz I needed to fax it to Medicaid to prove I had met my SOC for that month. So there will be absolutely no out of pocket expenses for you to pay.

2. I've only needed the 1 visit to the ER for approval of my surgery. Reason being I was previously covered through Medicaid on Humana.  However when my surgeon submitted for approval I was told he was out of network for Humana. So I switched from Medicaid Humana to Straight Medicaid.  

3. By the time I was on the SOC I already had all pre-op testing done. What I'd suggest for you is to find out which Dr's accept the SOC for the necessary pre-op clearances and schedule them all in the same month. To be safe make them middle of the month so that you can be sure you've had time to meet the SOC & submit it to Medicaid. Your surgeon office should be able to help you find where you can go. Also your surgeon office visit mat not be that much out of pocket. I only saw my surgeon 2x before surgery. 1st time was to meet & discuss my options.  2nd was when he did my endoscopy for the pre-op. 

Clearances that I needed:

Psyche 

Cardiologist

Endoscopy

Letter of medical necessity from PCP

6 months of supervised visits from PCP

Who is your surgeon?  Have you started the process?  

Hello. I know this was 3 years ago but i have a question. Im having the surgery on october 24th this year. And im also on share of cost. They gave me 3 months, im doing everything that needs to be done for the surgery. Just like you im going to the ER with a complain. Do you think everything will be okay? Cause i see that you mentionned that medicaid ask you for 6 months. But my medically needy share of. Cost only ask for 3. It was suppose to be even less. Do you think they're going to tell me to wait more?