Medicaid Approval......

For any one who has had medicaid or knows of anyone who has had it and has applied for Gastric Bypass Surgery, I was wondering if anyone has been approved for surgery without having a 5 year medical history?? I realize that is one of the requirements, but my surgeons office sent it off to medicaid anyway. We both received a letter asking for more information, so I had my regular doctor and my surgeon send letters back to medicaid explaining that I only have a 3 year medical history due to my not having insurance before this time. So I was just wondering if anyone has gone through anything like this or knows of anyone who has and if so what were your results?? Also, does anyone know how I can go about finding out what the medicaid requirements are for other procedures. I'm having a hard time finding a surgeon for lap band that accepts Medicaid. Does anyone know of any?? I'm trying to keep my options open in case medicaid denies my procedure and seeing what else I might be able to do!! Thanks in advance for taking the time to read this and for any replies! Sincerely, ~Sabrina

Hey Sabrina, I have Medicaid (as my secondary & Medicare as primary). I didn't have a problem with the 5 yr medical history requirement but at the time that I seeked approval the CSR that I talked to at the Medicaid office said that it just had to be documentation from anything from at least the past 5 years showing my weight. Did you see any type of doctor that wrote down your large weight other the the three years you had medical coverage? It can be from anything... school... health screen at Plan Parenthood.. etc.. Medicaids requirements for the lapband are the same as for the RNY. I know my Dr.. Dr Clark.. takes Medicaid for either procedures but only at the begining of each year. But you are more then welcomed to call his office. You can also call the 1-800 on the back of your Medicaid card and talk to a CSR and you can ask any and all questions with them. Good Luck Jodi

Hello Sabrina, I too have Medicare/medicaid. I started out with Dr Clark, I did have 5 years of records. My problem was with Medicare you have to go to a hospital that is a Center of Excellence, and Dr Clark did n"t go to the hospital I needed to be approved. I was very upset due to his staff told me they were in process of getting COE at one of the hospitals he goes to. Found out later it will most likely be a while before that hospital gets that COE. So start with a hospital that has COE, then find the doctor. I am now going to Dr Douglas Kadeabk, he accepts both medicare and medicaid. I started with him and St Vincent Bariatric center in Carmel. I would call your Medicaid caseworker to see if you have to have a COE hospital before starting and having to wait months with I did with my doctor. I am now waiting for medicaid approval and my records were sent. Not like the frist doctor's office told me they sent them and didn't. I lost all faith in that office.Good luck. And keep me posted. Blessings, Gail

Gail, She ONLY needs a COE hospital if she is Medicare Primary or Medicare Only. If she has Medicaid, not Medicare, she can go to any hospital or surgeon that will take only Mediciad coverage.

I heard St Francis got their approval....and many more to follow this year. Government moves so slow at times Dr. Clark does the surgery out of St Francis. Happy journey to ya!!