Does anyone know about.......

Iowa Medicaid Title 19 I am wondering how long does it take to get approval from Title 19 once submitted? I am at the end of the surgery process, I have had all the testing...Sleep study, F/U appt. for sleep study, Psych Eval, nutrition consult x2, surgeon consult, some bloodwork for a pre-exsiting condition, ABG and PFT's, all done and resulted, surgery date scheduled and lost 14lbs of the 15lbs required to lose pre-op. Now it is time for submitting for approval. I called Title 19 and they said that WLS is a covered benefit. I was told that prior approval is needed and that I had to have a BMI over 35, be 100lbs or more over weight and have one or more co-morbidities cause by obesity. I have all three and then some. Anywho, I wanted to make sure that I have done all these things before she submits to insurance. Now, I went to talk to Melanie, insurance coordinator and she handed me some disturbing news. She gave me a letter from Medicaid that was sent to another patient as an example of reasons that I could be denied and the letter stated: "Your request for gastric bypass procedure review on the above case was shared with a reviewing physician. Following review of the documentation you provided, the physician reviewer determined the proposed procedure is not medically necessary. The physician's comments concerning the pending denial are as follows: Documentation provided for review did not support the patient is an appropriate candidate for gastric bypass surgery. The presurgical evaluation indicated the patient was a "fair surgical candidate" and he anticipated "fair compliance". The evaluator doubted her level of commitment. Prior to consideration of surgery, the patient should attempt 6 months on a physician-supervised diet. This sample notice freaked me out and now I am scared that I may have to do a 6 month supervised diet. If you have Iowa Medicaid Title 19 and you are or have had surgery, did you have to do a 6 month supervised diet, even if you have several co-morbidities caused by obesity. I need some clarification with this. Any one can respond to this posting, either Pre or Post-op. Thank you for you input, Your WLS partner, Nissah The F.AT Slayer 360/346/???/180 28 days 2 go...... hopefully now.....

Hi Nissah, I have title 19 and am just starting the process...you are farther along than I am in the journey. I know there are a couple of people who had WLS and Title 19. I have heard that some have had to do the diet...and others who havent. I guess it depends on the case. I orig was referred to Iowa City to the U of I. The information I got from them is they would not even see you unless you had 2 YEARS of supervised diet because that is what Title 19 requires. So, in that perspective....6 mos doesnt sound so bad right? But I am with you on this. You are like me...you wanna get this all over with and want to get on with your life. My first consult isnt till the end of August in Grinnell....Keep us posted on what you find out. Billie Jo

Hiya Nissah, I'm on Title 19,The first time took weeks but I got denied & the 2nd time on 2 days & I got approved & I am haveing surgery next Wed...So give it at least a couple of weeks...GOOD LUCK {{{HUGZ}}} Janelle

Oh by the way I did have to do a 2 month supervised diet...

Morning Nissah I also have Title 19 they paid for everything but $2!! I didn't have to have supervised diets etc BUT I had the past 5 yrs medical records sent to them so they had everything in front of them. I also get Medicare & that was their requirement. I personally think this is a good idea to send as it gives the dr's title 19 use a chance to see what has been happening to us example being diagnosed with high blood pressure/diabetes etc. What kind of programs the PC had you follow. Its all there in their notes. This doesn't just have to be from PC if you have had other dr's be sure to get their input & records. Also have your PC & other dr's write a letter of recommendation for you AND write your own. Write from the heart why you need surgery, they already know statistics they need to hear from you why WLS is important to you. You should hear back from them in 10 days to 2 weeks. Sorry I don't have the 800# anymore to call Marilyn but maybe surgeons office will have it. Marilyn is the one who passes your info on to the dr's that decide if you need surgery & if title 19 will cover. Good luck & keep us posted. Hugs Carolyn