A hello and a question

My name is Alisha and I am from South Portland.  I am going through the program at the Bariatric Center through Maine Medical Center.  I am 25 and currently have a BMI of 43 or so.  I don't have any major medical problems as of yet; mild sleep disorder, and backpain/sciatica mostly.  I have two sons, 2 and 3. I am almost done with the visits with the social worker and nutritionist {I have an appt Thurs} and then hopefully my file will be sent to MaineCare for approval.  I was wondering if anyone else got approved through MaineCare and how long it took to hear something; how hard it was to get approved etc.

Hi Alisha, I can't answer your question - but I believe MoodyBlueEyes also has MaineCare. I did want to welcome you to the support group and wish you the best on your WLS journey. Candace

Welcome Alisha,

Yes, I have Mainecare, but I am way behind you in the process so have not been submitted for approval yet and can't help you with a time frame. At some point I found this info online in a MaineCare manual:

H.    Gastric Bypass or Gastroplasty Surgery

 Reimbursement will be made to the physician, hospital or other health care provider for services related to gastric bypass or gastroplasty surgery only when prior approval has been granted by the Department. Approval will be granted only when the physician requesting prior authorization can clearly document in writing the following conditions:

1.   The patient's weight is at least twice the normal weight, or one hundred (100) lbs. over the ideal weight;

2.   The patient has been unable to obtain the desired weight loss through non-surgical means under appropriate medical supervision, including psychological evaluation  

3.   There is an appropriate pre-operative, post-operative, and follow-up plan by the physician and dietitian; and  

4.   The surgery is medically necessary to correct an illness or condition caused by or aggravated by the obesity, such as diabetes or hypertension.

It is my understanding that if you meet those requirements, approval is not difficult, and I would assume that MMC would not have gone this far with you iof they didn't think you would be approved.

Good luck and please let me know how long it takes for you so I will know when my time comes.

 I

Thanks for the info!

HI Alisha Welcome, I have maine care disability, Have had 3 back surgeries, that all started with sciatic pain, Long story short,  Last year I was submitted and approved in about 3 weeks,  My center  took care of all of what was needed and presented for me, I do not have sleep apnea, nor diabietes  Maine care has been a huge blessing to me, I just recently after 1 year with a lawyer won my social security disability, My own claim no ssi,  and  was over income for maine care, but because I work now, have my candle business  I was able to keep it under maine care working disabled..  I do have to pay a small fee monthly  and my daughters was kept for 18 months at 100.o a month. but long story short.  maine care did approve my Lap RNYGastric by pass in just 3 weeks.  Going through all the process and time     is  preparing to be submitted to insurance, all this documentation will help your case.       I am 38 and my Bmi was 41.  I pretty much have spine disorders and have had few others. but the insurance specialist at your center will handle all that,   and Normally the process takes a good 6 months plus before you are submitted. everyone is a bit different.   Also there is an insurance board you can go and look at  others who were approved or denied as maine care patients.  I did that as well.  Welcome and  its never too soon to Lose!! I began the day after my first seminar, I was so inspired and  Knew that this time was going to be different!  Scented Blessings Allicca march 10th 2008 I will be 3 months out.

Welcome to our little family Alisha nice to have you here.

Welcome Alesha,  So happy to add new faces to our little family.  Best of luck and keep in touch.  I am also pre op, happy to see a few new people that will be close to my wls date (not sure when yet)

Hi Alisha,(love the way your name is spelled) Welcome, I just found this board a bit ago and it is so helpful and supportive, i think you will like it here, if we don't know we know someone who might know! kate

welcome to the board. you'll get lots of advice here. we are a tightknit family and welcome newcomers all the time. we're here if you need anything. good luck with your journey. you've made a wonderful decision for yourself.

I have maine care and i was approved in a week. But I assume that was fast.