Wanting some help

I was wondering about the whole procedure of getting qualified for the surgery of a gastric bypass through MaineCare. I have went through all the nutrition class, physcologist, physical therapist, etc. Now I have my date to see the surgeon on November 20th. I am seeing Dr. Clough, but I am hoping that I have not just went through all of this for the fun of it. A little history of myself: I am 25 yr old, weight 308, I have high blood pressure, high cholesterol (which is sorta boarderline - 218) I am taking Zocor 40mg for that, Boarderline diabetic - taking Metformin 500mg daily, and I have had gestational diabetes with my pregnancies. I am wondering if MaineCare is going to ok the surgery and pay for it, or what. I feel that I don't really have enough problems or whatever to get MaineCare to pay (always seems like they are paying for less and less these days) But I am really excited that I have made it this far, just hoping not to get a disappointment. Anyone have any advice that has went through MaineCare or anyone that knows more than I do?? Thanks

Hi Kristy, I have Medicare and MaineCare. Medicare does not have a pre-approval...Once I saw Dr. Clough, he submitted a letter to MaineCare. I received approval in about 10 days (I think they have up to a month) Received my surgery date in less than a week after that (will happen Nov 2). So it all went by pretty quickly. My understanding is that they require at least 1 comorbidity these days, and, based on what you've said, it looks to me like you'd qualify. Good luck, Karen

Thank you Karen for your help... your post made me feel much better. I am so ready to lose my weight, that I am very much hoping that MaineCare will pay. Sounds like you got a very fast reply. That was the same with me about my appointment to see Dr. Clough, I went to the dietician on the 19th, and she told me not to expect a letter in the mail tomorrow... but I did! I got a letter on the 20th that I am scheduled to go see Dr. Clough on November 20th, I am getting very excited. Good luck on your upcoming surgery!!

Hi Kristy I had MaineCare and Medicare, also. I have pretty much the same story. lol My whole experience was super fast. It's very rare, so I'm told...for things to go as quickly as they did for me. I started the whole journey in May of this year, with the informational meeting. I had my surgery on aug. 25th. Not bad, huh?? lol You have done your part, for now. Going to the appointments, and choosing the surgeon is about all you can do for now. Speaking from experience, Dr Clough is a God-send, as far as handling the insurance aspect of this. He seems to know exactly what to say in his letter to them. He will talk to you at your appointment on the 20th, and will use the info that you give him, and your medical records to get MaineCare to do their part. The insurance co has 30 days to respond to his letter, but it took a little over a week for me. Let us know what you hear. I'm pulling for you.