Question about medicaid: (Buckeye Community Health Plan)

Hello all, I am so glad I found this website!!!!! I'm new here, and have a question. My medicaid insurance used to be through "Summa" (Summit County). Now they've sold their medicaid accounts to "Buckeye Community Health Plan". Does anyone know how Buckeye Community is about covering bariatric surgeries? Please feel free to reply with any info. you have on them. Also, under the "insurers" section: When someone lists "medicaid" as their insurer, is that a general-use term? Like, could they have: (as an example), "Summa", but since it's still paid for by the state, they just list insurer as "medicaid". Hope I didn't confuse everyone on that question. I'm asking because I didn't see anyone list Summa or Buckeye Community as their insurer. Thank-you for your help. I look forward to making many new friends here . Kim.

Hi Kim and Welcome, I really don't know about the medicaid with Summa or Buckeye Community Health Plan, However you can call them and ask them straight out if they will pay for WLS, and what the pre requisits (sp) are. That way you will know if you have to do the supervised dieting. I wish you the best of luck in your Journey, and I hope to see you around on the board. This is a great group of people. Hugs, Lisa

Hi and Welcome Medicaid is a general "insurance" word for coverage of those less fortunate in the pocketbook. But their is a difference in coverages I believe. Well anywho's I'm on regular Medicaid, got approved, once my paperwork was submitted it didn't take them all that long to get to it. However that was a year ago. Now my friend is on Paramount Advantage (through Medicaid) and her approval came through way quicker and she was able to go to a surgeon here in T-town, but I had to go to Cincy. I was ready my sons booklet on the BCHP, and what it does say is Weight loss surgery IS covered IF medically neccessary. To get full details of their requirements, call that toll free # that is on your card. h & p's

Medicaid exists in two ways: regular Medicaid, and I think it's called HealthyStart or something like that...it's sort of like a Medicaid HMO. You can't have Cigna, Aetna, etc. and be Medicaid. Good luck, Dr. C The Deaconess Surgical Weight Loss Center Cincinnati, Ohio (513) 559-2545

Special THANK-YOU to Lisa, Vickie and Trace, for your nice welcome and help. I called Buckeye Community today, and after speaking to many different people, I got a wonderful lady who helped me a lot! She did say, of course, that they would cover it if it's a medical necessity. She said they require a 6 month weight loss plan monitored by my physician. I told her of my medical problems, BMI, etc., and she said based on those, it sounds like it might be covered, after the 6 mo. plan. I also saw my PCP today, and he recommended the bariatric surgery for me. He said with my medical problems and current weight, that he didn't feel that a "diet" is going to do much for me. (My endo said the same thing). I don't know if the insurance co. will take that into consideration, and dismiss the 6 month "diet" plan or not. Let's keep our fingers crossed! As most of you know, it's a constant yo-yo with diets. I've tried so many, I've lost count! He made a referral for me to a general surgeon who does the surgery on a regular basis. He said it would be best for the surgeon's office to complete all of the paperwork, since they do this all the time. I rushed home, and called the surgeon's office for an appt., and the lady in the office informs me that they do not take that insurance . I was really hoping that I could go to someone other than the Summa Hospital Advanced Bariatric Care Center, because they want almost $2,000 up front for tests, evaluations, etc. For some reason the girl I spoke to said no insurance would cover those things?? I guess I will be calling all over Monday to find a good surgeon to meet with. Buckeye said that if my physician makes a referral, that they would even let me go out-of-network, as long as the surgeon will accept their (Buckeye's) payments. I really hope to find someone soon. I will keep you guy's posted. I also welcome any input. Thanks!! .