question-Indiana Medicaid

does anyone know what criteria Indiana Medicaid uses when evaluating PAs for bariatric surgery?

specifically, i'm trying to find out if they require a period of supervised weight loss.  this question has come up at work, and i'm getting the usual run around and stalling from my Medicaid provider reps.

thanks!

Indiana Medicaid does require a 6 month period of supervised weight loss attempt. I just got approved by Medicaid for my December 15th surgery date. I had to do 6 mons with my PCP and also with a dietician. I also had to have a drug screen, a psychological evaluation and 2 years of medical records showing I had been obese for 2+ years. My PCP had to write medicaid a letter of recommendation as well. I hope this helps and if you have any other questions, feel free to ask. Good Luck getting approved!!

it is not for me, i have had the surgery.

i work for a facility that offers the surgery, and we are trying to find out what is necessary for Mcaid patients to be approved, so we can offer it to our Mcaid patients.

Mcaid provider reps are no help whatsoever.  IF i got any response, it was "i'll get back to you."

may i ask how you handled the 6 months of supervised weight loss?  the Mcaid rep will not even tell me if the dietician visits are covered.

Oh ok, congrats on already having the surgery then! I have MDWise and yes all the types of Medicaid have slight variances on what they require. One requires you attend support groups for three months first, however, mine did not require that. I called my PCP and told her that I wanted to have the surgery and asked her if she would do the 6 mons with me and she said yes. It is vital that the PCP document you once a month for 6 mons and each visit record your vitals, weight, current diet and new diet suggestions. Also be sure exercise is discussed and recorded. What you are doing, what your goals are with exercise. My medicaid DID cover my dietician visits. My dietician then sent her notes to my PCP so that they were included in my medical file. I hope you get some answers soon. If you need to ask anything else, feel free to do so.

Basically what the above poster posted. However, you can call the toll free customer service number on the back of your Medicaid card and with your ID number they'll tell you specifically what is required and IF you get a nice rep, they'll actually tell you how to specifically word or exactly/specifically what documentation they need for quicker approval (mine did at least). If you have any questions at all you can call them too... they've always been a great bunch of helpful people. 

 

Good Luck
Jodi 

i work as the Mcaid specialist for multi specialty clinic.  the nice Mcaid reps must all be on the participant side.

the provider reps are hostile, rude and not very well informed. 

i've had the surgery.

the doctor i work for wants to know what Mcaid's requirements are, to see if we can offer it to our Mcaid patients or not.

Mcaid is not exactly forthcoming with information; i called six people today for an answer to this quesion.  most of them ignored me, one person went so far as to say "I'm not going to tell you" (nice, huh?) and the rest said they would call me back immediately.  it is a good thing i wasn't holding my breath waiting for those calls.

WOw... that's... just...... damn frustrating I must say. I have a letter that Medicaid mailed to me when I had my surgery in 05 that had ALL the then requirements. They OFFERED to mail it to me when I called them. I'd be more then willing to call them and get a new updated list for you if you can give me an address and a name to mail it to once I recieve it... or I can just ask them over the phone and let you know... either or both... doesn't bother me at all. I'm more then willing to help out. 

 

Let Me Know
Jodi

I currently do provider education for one of the IN Medicaid MCOs. I'm not sure which program you need information on, but I wouldn't call the 800 # for specific information on coverage. I would try and get ahold of your local provider education rep. Since there are 3 Managed Care Organizations plus straight Medicaid (EDS) you should probably get the requirements for each program that you take since the MCOs don't have to follow the exact guidelines for straight Medicaid. If you PM me and let me know which plans you accept (Anthem, MHS, MDWise) I'll look and see who I have in my files as local contacts for you.