indiana medicaid

has anyone had experience dealing with indiana medicaid and trying to get approval for RNY

You can start the process by calling the customer service number on the back of your Medicaid card and telling the CSR that you and your PCP are interested in WLS approval and guidelines. You will need your Medicaid # in order to talk to a CSR and have your PCP information available incase they might ask. THey will send you and your PCP and approval guidline form to follow. They will also send your PCP all the necessary forms to be filled out. Just follow the guidelines regardless of what WLS procedure you are interested in. See if Dr Huse's office will submit the forms from your PCP's office as well as any forms Medicaid might require of them also, other your PCP will have to send everything off for the approval process. Make sure to also ask the CSR to send you an updated list of approved Surgeons for WLS. I have a guideline I can share. It's for 2005 approval so I'm not sure how outdated it is, but at least it will give you an idea at what you might be looking at. The Following is a list from the Indiana Medicaid Board on it's guidlines to approve WLS. *. A current BMI of 40 or greater *. A current BMI of less then 40 THEN with at least a minimum of 2 of the following conditions: >.Type II Diabetes >.Hypertension >.Sleep apnea requiring the use of a c-pap >.Degenerative Joint Disease, affecting the lower back, hips, ankles or feet. >.Pseudo Tumor Cerebri >.Severe Urinary Incontinece >.Asthma >.GERD >.Obesity Hypoventilation Syndrome >.Plycystic Overian Disease *Proof of medically supervised weight loss attempts documentead in your medical records. This can/may include visits with a registered dietician, but a DOCTOR must have also overseen your weight loss attempts and moitored your progress for a period of at least 8 but no more then 18 months within the last two years. These do NOT necessarily have to be consecutive months but must total at least 8 months of documentation within a two year period. This can also include recommendations of following any diet protocols (ie: requests to limit salt intake for high blood pressure, eliminate high quantities of sugar for diabietes, and etc). * Documented 5-year history of Morbid Obesity (BMI of 40 or greater) - this can/may include regular weigh documentation for regular office visits within a period of 5 years. *At least one attempt at a pharmacological management should be documented. Allergies or absolute contraindictions to these types of drugs will be considered. * A current history and physical from your PCP. Report must indicate no known presence of liver and/or kidney disease. *A referral and a letter of Medical Necessity from your PCP addressing all your health problems pertaining to your high BMI/weight. *Recent results from a TSH and Urine Cortisol level to rule out Chushing and Thyroid disease. !!*A statement form provided by us and signed by your PCP, indicating that you do not abuse drugs, alcohol, or tobacoo. !!*A letter from yourself indication your agreement to commit and participate full in pre-op and post-op follow up programs that may include dietary and behavioral modification counseling. *A pshychological evaluation by a Psychiatrist or a Psychologist.(Please check with the referred surgeon/center or the surgeon/center you have picked out to be referred to as they may have a evaluation process or Psychiatrist/Psychologist that does this for them as part of their services to you). Medicaid's policy is NOT to provide any pre-qualification approval untill they recieve ALL these documentations. If you also carry Medicare along with Medicaid - it is Medicare's policy to only approve if Medicaid is willing to approve, otherwise if you have just Medicare ONLY they will pay with no approval necessary. Also here is the number for EDS, who manages and controls Indiana Medicaid's billing, approval, and denial or for any Medicaid Insurance questions or customer support. 1-800-577-1278 ***please make sure to have your Medicaid number for identification - they will not take your name just your Medicaid Number Only). Hope this helps you have a decent idea. It happened for me relatively pretty easy w/o any major hiccups. Good Luck Jodi

Another option, if you feel your weight is high enough to impact your ability to do your work, you might try Vocational Rehabilitation. I am a VR counselor and have successfully helped a person to get gastric bypass. If you think of going this route, send me a line, and I'll give you some ideas.  Linda Vicory

 

Hope want I sent helps.Good luck.