New here, have questions about WLS & medicaid

I am new to this site. I have a few questions. I have Ohio Medicaid and I'm going to see a surgeon tom. I am 5'5 1/2 & about 230. I have tacheycardia, stage 1 hypertension, Reflux, depression, degenertive disc disease, arthritis in back and knees & I'm only 29. I was wondering if anyone has delt with ohio medicaid and what is it like to get approved. My BMI is 38.3. I don't think they will consider any of my co-morbidality's to be life threating and my BMI is not quite 40. Does anyone know what they are like to deal with or is there something I can do to help. I really want this surgery. With my back problems, it's impossible to exercise any more and I just keep getting bigger and bigger. If anyone can help please let me know. THANK YOU!

Hi Kim! I have a lot of experience dealing with Ohio Medicaid. Unfortunately, they tend to only approve when your BMI is 50 or above and you have at least 2 severe co-morbidities (high blood pressure, sleep apnea, diabetes, high cholesterol). I am sure there have been some exceptions to this and some people have slipped thru with a BMI slightly lower than 50 (48, 49), but in my experience I think I have only seen that happen once. Medicaid will tell you that if there is medical necessity and your BMI is over 40 that they may cover it. However, from what I have seen that is very untrue. Wish I had better news! Good luck! Tracy Burch Insurance Coordinator Dr. Trace Curry's office 513-559-2544 [email protected]

This was from a post I made to another member.. Some of it might Help. I had my WLS paid for by Ohio Medicaid after a 2 and a half year battle. I had Cardiomyopathy, Cardiomegally, RH, Sleep Apnea, Gerd, High Blood Pressure, High Triglycerides, Prediabetic, Joint Pain, Gout, Neuropathy in my feet and hands. Even with all my comormidities and being 310 pounds at 5"2 it was a battle all the way. But I never gave up and kept fighting. Below is a post to another member who is in the appeal process. Just remember you will most likely get denied the first time. But dont give up. Keep fighting like your life depends on it.. Because it does. Heres the post RE: Today was my appeal hearing Response from Loraine May at 12:35 AM EST on 01/19/2006 Byesville, OH - RNY (05/06/2005) - Dean J. Mikami, M.D. Keep believing that this will happen for you. When you go into your hearing leave all the medical papers behind. Bring friends and loved ones and have them read letters telling the reasons that you should have the surgery. Ask everyone who loves you and knows how you struggle to write letters and you are entitled to have those persons present at your hearing. Allow them to read those letters to the judge. Make a plea to the hearing officer about all the medical bills that are going to continue to add up due to obesity related illness and medications. My pharmacy printed up and itemized list of all the medications that I had been on since the day of my initial application for surgery. How many thousands and thousands of dollars my prescriptions had cost the state. If you have had Drs visits and Hospitalizations ask for itemized bills from each provider and hospital. Add on bills for tests, etc. I took all this the day of my final hearing and the judge was impressed with how much all this was costing. I had the cost of the surgery on paper and showed them that too. The final thing I truly feel sealed my final approval was a letter written and read by my 12 year old son on how he had seen me suffer and that he didnt think he was going to have a mother much longer if I didnt get the surgery. I found all the medical records in the world didnt mean as much as that emotional plea by my son. I pray that some of these ideas might help you. Yes these things are time consuming but as we know the state is hurting financially and if they can see how much $$$$ they are putting out on you to keep you going in your current condition and how much more you will cost in the future as you get older and unhealthier. If you have any questions feel free to contact me. I might be a little slow in getting back to you , but I will do my best. I am working full time and babysitting my little grandbaby. These are all things I couldnt of done 7 months ago. If you need someone ( like me ) to write you a letter of how this surgery has changed my life I would be happy to. They have to allow these letters or speakers as evidence in your appeal. I will keep you and all the many many others awaiting approval in my prayers. I thank God each and every day I had the patience to out wait Ohio Medicaid and get my approval after 2 1/2 years. BIG HUGS.. ANd Please Never give up faith that it will happen for you.. God works miracles and can touch the heart of your hearing officer. Dont be afraid to show your true emotional state that day. Let them know just how very much your life depends on you getting this life changing procedure. The Best of luck to you Laura I hope this helps.. Good Luck.. Hugs from Southeast Ohio Laura 310/152/120 Someday!!!