Successfully granted WLS surgery with Medically Needy Cost of Sharing? Anybody?
Hi there, My daughter who is 19 has been on medicaid and has completed nearly everything needed, and the surgeon was planning on December surgery. Now today I get notice that upon my renewal ( and absolutely nothing has changed in my household ) that she has been switched from straight Medicaid to share of cost for $1200.
Should I try and get her current surgeon who does accept medicaid, although I have not spoken to them about share of cost, or try and switch to a different dr. Is the surgeon going to be ok with trying to work around your share of cost? I mean if my daughter goes to the ER on the 1st, and the surgeon submits the approval, how will we time it perfectly so that she will be on straight medicaid when the approval is received and viewed? I am just a little confused how to work this all.
on 10/31/15 8:31 am - Margate, FL
The Dr don't work around share of cost unless he accepts soc. Don't worry about the Dr aspect of the process. Bcuz if she has already done all the necessary tests & appointments she shouldn't have to go bac****il it's time for surgery. Now when I went to the ER it was maybe 1 week prior to my surgery approval. After the ER visit it only takes a few days to obtain the billing paperwork. You have to go to the hospital billing office and ask for the bill. Which you have to fax to Medicaid to prove your Soc has been met. If possible the hospital billing office can fax it. But I'd make sure you actually see them fax it. Once Medicaid receives the bill you are now on straight Medicaid. If it was me I'd go to the ER on Dec 1st in the early am hours. So by the 3rd you can fax the paperwork to Medicaid. That way you're on Medicaid for the rest of December. But be sure your Dr plans to do her surgery in December. Bcuz if he's booked for the month you have to re-do the entire ER visit the next month.
DS: 5/28/14
HW: 310
SW: 302
CW: 160 ( 1 year post-op) 160 lbs gone