So confused and discouraged

Hi everyone. I am so upset right now. I had an appointment next week to submit all of my paperwork and required testing to Medicaid for approval for Gastric Bypass. Well, first setback is my PCP's office is giving me the run around about getting my medical records. I put in a request in March, and they lost it. I just signed another one on April 5th and the lady said the copy company didnt copy them, AGAIN! I have called 3 times in the past week and no one can give me an answer. So, I had to reschedule my appointment for May. Now, I spoke with the Coordinator for the office and she told me AGAIN that Gastric Bypass is not covered. Am I missing something? I called 3 times to the Mediciad office in Springfield and they said it is covered if it is a medical necessity. I cant get a Lap Band because I have Lupus, and Medicaid does not cover the sleeve since it is "experimental". The only thing I can can get is the bypass. I am getting so discouraged. Anyone here have any experience with Medicaid?

 I'm so sorry you are having this trouble.  I had to call my PCP's office several times and make a separate appointment until I finally got her to send her letter to my surgeon.  

As far as the coordinator telling you that gastric bypass is not covered.... is she telling you that medicaid will not cover it or that they won't accept medicaid for it?  If you meet the requirements for surgery, medicaid will cover gastric bypass.  They covered mine, and I know several others on here had their surgery covered.  I'm pretty sure, one person (sorry I can't remember their name) even had medicaid pay for the DS.  I had no problem from medicaid.

I would talk to the coordinator again about this.  If you want & need gastric bypass, then that is what you should get.  I know that medicaid will cover it, but the problem may be coming from your surgeon's office.  Good luck.  I hope everything works out for you.

Thanks sam_c! My PCP gave me the letter for the Gastric Bypass. It is the medical records department giving me issues about giving me a copy of the records. The coordinator said everything needs to be submitted to Medicaid at one time. As for it not being covered by Medicaid, I am wondering maybe its just their office that doesn't accept it. If that's the case, I can just go somewhere else. I just hope I dont have to start everything over again.

I had DS on Medicaid 3-17-10. I went to Peoria Surgical Group and had surgery at St Francis Hospital in Peoria IL. At no time did anyone request my medical records. They also did not submit me for approval.  They are a Center of Excellence and if you meet their criteria you have the surgery and they bill medicaid its just that simple. Below is the link to their site, go to billing and Medicaid. You will be required to jump thru some other hoops because they are a COE but Medicaid has nothing to do with it.

GL Ronda


http://www.osfsaintfrancis.org/services/OutpatientServices/W ellness/SurgicalWeightLoss/

So, basically it is the place that I am going that is not taking Medicaid? I did all of the requirments already and if they didn't take Medicaid for bypass I have no idea why I did all of this for. They said that Medicaid covers the lap band only.

Hmmmm im not sure what to say. How far along in the process are you? What all have you done? Doesnt make sense to me yet. Tell me more. Did you meet with the surgeon? Did you speak to the billing specialist?

I will help you but I need more info.

R

I already met with the surgeon. He said the bypass was covered and I can't get the lap band because I have Lupus. I have already done the upper GI, gallbladder ultrasound, psych consultant, nutritional consult and sleep study. Everything was good. Now I am just waiting for the appt with surgeon. The billing specialist is the one saying the bypass is not covered. She said maybe due to special cir****tances with the Lupus, Medicaid might cover.

If you have already done all of those things I would think you are going to be fine. To be honest with you I dont think you will have any problems. Do you go to monthly support meetings? If you do ask around and you will see Medicaid is the absolute easiest way to get approved. I wish you all the luck in the world and keep me posted please.

R

Thanks so much. I feel better now! I will keep you posted!