Medicaid Revision to Duodenal Switch

A friend of mine had the RNY about two years ago.  Her weight loss was poor and now she's gained it all back.  Some might say this is her own fault, but I have heard many stories of this same thing happening with the RNY which is part of what convinced me to get the Duodenal Switch.  My results have been great so far and I've seen a number of people who have gotten a revision from RNY to the DS.  She is on Oregon's version of Medicaid.

So my question is whether any of you know if Oregon's Medicaid plan covers the revision from RNY to DS?  If not, is there a way to file a review of medical necessity through the state?

Thanks for any help you can provide!

Christy
SW 368 /CW265/ GW170

The Oregon Health Plan (OHP) is the state's version of Medicaid.

I checked OHP's prioritized list of health services that was effective April 1, 2009.  WLS is covered under line 33 only when the co-morbidity is Type 2 Diabetes and the BMI is 35 or more.  Those without this co-morbidity are still considered far lower in priority under line 608 of the same list and are therefore not covered under the OHP.  Nothing was mentioned about any revisions.

Any challenge to this list should be directed to the Oregon State Health Services Commission.  Click on "Contact Us" on the left side of the web page.

Hope this helps!

Thanks for your help Vicki!  I had looked at that information and it wasn't clear to me either.  At least there seems to be an appeal process.  I think I'm going to post over on the DS board to see if I get more responses there.