Medicaid recipients left in the cold???

Hello, new to the forum. I had been posting a little on the Lap Band board, but I think I need advice from people in my state. I have Medicaid-Horizon/Mercy and live in North Jersey, in fact, Jersey City, and I have the same problem as the person who posted about Aetna. I can't find a participating surgeon and was given a list of general surgeons by Horizon who all say they don't perform bariatric. I have decided to go with the band so my search is even more limited. I am pulling my hair out now because Doctors like Dr.Goyal who USED to take medicaid have now dropped it. When I tried hospitals in South Jersey they told me they couldn't accept me from such a distance because of the need for follow-up visits. I have, of course, found many options in New York City which is only 15 minutes away but my insurance says no New York, UNLESS there is an urgent need and there are no Doctors in network in my area, etc. All of this would have to be recommened and approved by my primary which I have not chosen yet, since I am starting on Horizon June 1st. I guess if I find a sympathetic primary I could plead this case. So my first question is, Does anyone know of a primary in Jersey area who would be sympathetic to wls? Then second, if anyone knows of a Medicaid/Horizon/Mercy Doctor who either is in the Jersey City area or out of it and is willing to take a patient from a distance? Maia Maia

I have Horizon, and my doctor is in Old Bridge. Her name is Sharon Ryan. I can give you the number if you're interested. I've only been seeing her for 3 months, and she wrote the note for me based on what I told her and my history. She's very sympathetic, but she will go over ALL the risks with you, not to persuade you to reconsider, just to make sure you have all the facts. Schedule a new patient physical, and go in armed with lots of info to support your case, and you should be good. Good Luck!

Thanks sue. Yes, I would be very interested in her number although I am not sure where Old Bridge is and how far it is away from me. In fact, I am completely new to the New Jersey area in general.

I sent you a personal e-mail with Dr. Ryan's info, including the address, so you can do an internet search (yahoo maps, mapquest, etc.) and find out how far she is from you. If you decide to go with her, make sure you schedule a new patient physical. Good luck! Sue

Maia, i am not sure but i think it is required of insurance companies if there is no provided in the immediate are within i think 50 miles..don;t qouote me on it that they have to allow you to go to another area. post question to see if it is true. actually i think this is fact. i know of a person on here that her insurance had to let her go to jersery shore medical hospital in neptune because the hospital she was suppose to go to for their provider list di not do biariatric surgery. Call the insurance comissione in the state to see if the rule applies. good luck to you! Joyce

Hi, I have Medicaid/Horizon/Mercy aka New name- Horizon NJ Health. My surgeon is Dr. Pasupathy from Bridgeton NJ.(south jersey) I had no problem what so ever and there wasn't a waiting list. I hope you found the solution to your problem. Hang in there. **Hugs**