Need Info. on OHP insurance in Oregon.

Hemi4Ever
on 8/30/07 2:26 am - Oakridge, OR
           Hello Everyone, I am a, "Newbie", so I can really use some information about having Gastric Bypass Surgery, done in Oregon using OHP Insurance. I have heard that it is possible, but otherwise, have been told that they will not cover this. Any help will be appreciated. 
DBlazer325
on 8/30/07 5:49 am - Portland, OR

I think medicare will cover WLS, I don't think the OHP will, not unless your PCP can prove that it is medically necessary.

 

Peggy

Hemi4Ever
on 8/30/07 1:45 pm - Oakridge, OR
           Thank's DBlazer325's for responding, this is part of what I have heard.  One said that they would cover this after Jan. 08 for those who have a type of Diabetes, but don't know this to be a fact.  Hopefully, more will respond with more info. about this type of insurance.  Again, Thank's, for the responding.
Tamara V.
on 9/2/07 4:47 am - Portland, OR
Good morning, I work in a specialty medical practice and help patients navigate troubles with their insurance companies.  Bariatrics is not the specialty I work in, but we have a patient that we would like to recommend for bariatric surgery.  We've been working pretty closely with OHSU's Digestive Health Center and with OHP/DMAP.  DMAP has made it very clear that they will not pay for bypass or any bariatrtic surgery.  It's been a couple of months since I have talked with any of my contacts at DMAP so there may be a shift happening if they are now talking about covering it.  So far we have been told no way. Medicare will pay for bypass and, the last I heard, lap band.  My friend just had bypass a couple of months ago and she was told to expect to pay about $2000-$3000 after Medicare pays.  OHSU does accept payments, so it's not all due at once. Good luck! Tammy

Hemi4Ever
on 9/2/07 8:21 am - Oakridge, OR
        Hello Tamara, I apreciate you responding .  Will you see if there is any change to OHP/DMAP's policy, since you last heard ?  With all of the positive changes, that these types of surgery bring, maybe, OHP will change their view and cover this ?   Thank's
aluvzu2
on 9/3/07 5:54 am - Portland, OR
Hello I get my gastric bypass tuesday the 4th of Sept. 2007 and I have cigma. My mom has medicare SSI and she had her bypass done 4 month ago her copay was only $100.00 thats it. However OHP/DMAP will NOT pay for it. My sister has OHP and is 260lb and is only 4.9 feet tall. OHP does not have any money. Most ppl can't even get on it any more. Who ever said they would pay for it was wrong.. My sister had to get a job and then wait for her to get Insurance and then get it done. Sorry for the bad news but if u want it bad enough u will find a way. I did... Good luck. Take care
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