New and have questions about Medicaid and Unison insurance
Hi everyone. Hope everyone is good. I have heard about the different surgeries and how they benefit all of you and can benefit me. I basically want to know if I should go lap band or RNY ( I fear slippage and erosion's; thing which should only be associated with weather and not the inside of my body. I am leaning more toward RNY right now. I am 387 pounds and 6'2. I have multiple health problems and want WLS. I spoke with my insurance and they do cover lap band but they never said anything about having to do 6 month diet ( i hear it is different for each person but my insurance company just said to get paper work saying I need this surgery and that is it and that is easy stuff to get down). So is this 6 month diet necessary? Does my insurance require it (to those who have unison (which is medicaid by the way)? Is RNY a better decision if I am scared of slippage and need this weight off badly so slippage will just make things worse. Replies would be great. Thanks in advance. :)
The type of surgery you choose is entirely a personal decision. Do your research on each type, and talk to your doctor about what would be the best option for you. There are a lot of factors to think about, not just slippage and erosion. You need to think about any co-morbidities you may have (i.e., diabetes, heart disease, sleep apnea), how much you need to lose, and of course what your insurance guidelines recommend. There are forums on here for each surgery type. You may want to check those out and hear what those folks have to say. Research online, and of course ask questions here. Each surgery type has lifestyle changes that we must make, and you need to be aware of those and decide which you will comply with.
Sorry to be vague, but this really is a personal decision. Go to an informational session with your surgeon, listen to what they have to say, and ask questions.
I didn't have to do the 6 month diet, but it's not a bad thing to do. And 6 months will go by before you know it.
Good luck in your decision! And welcome to the PA board!!
Sorry to be vague, but this really is a personal decision. Go to an informational session with your surgeon, listen to what they have to say, and ask questions.
I didn't have to do the 6 month diet, but it's not a bad thing to do. And 6 months will go by before you know it.
Good luck in your decision! And welcome to the PA board!!
Julia
Hi :)
I had Medicaid at the time of my surgery. I had the RNY done in Feb. of 2009 and Medicaid required 6 months of meeting with my PCP. As long as I lost weight during the six months - no matter how much - they said they would approve it. Once all of the testing and the 6 months of doctor's appointments were done, my surgeon submitted the paper work and I was approved in less than a week.
I started at 365 lbs and I'm 5'3". I would recommend going with the RNY or looking into the DS. I was diabetic and hypertensive and I also had obstructive sleep apnea. Within a week of leaving the hospital after surgery, I was no longer on BP meds and my blood pressure has been on the low end of normal - a few days ago it was 117/69. Within one month, I was no longer on my diabetes meds and my a1c went from a 10.5 to a 7.2 and now it's at a 5.3. I no longer have sleep apnea, too.
Hope you get everything figured out :) I highly recommend visiting the DS and RNY forums and asking as many questions as you possibly can.
I had Medicaid at the time of my surgery. I had the RNY done in Feb. of 2009 and Medicaid required 6 months of meeting with my PCP. As long as I lost weight during the six months - no matter how much - they said they would approve it. Once all of the testing and the 6 months of doctor's appointments were done, my surgeon submitted the paper work and I was approved in less than a week.
I started at 365 lbs and I'm 5'3". I would recommend going with the RNY or looking into the DS. I was diabetic and hypertensive and I also had obstructive sleep apnea. Within a week of leaving the hospital after surgery, I was no longer on BP meds and my blood pressure has been on the low end of normal - a few days ago it was 117/69. Within one month, I was no longer on my diabetes meds and my a1c went from a 10.5 to a 7.2 and now it's at a 5.3. I no longer have sleep apnea, too.
Hope you get everything figured out :) I highly recommend visiting the DS and RNY forums and asking as many questions as you possibly can.
Proud mama of Mischa and Gabriel, both born post-op.
I was told if no weight is loss it doesn't matter sense the point of the 6 months is to prove whether you can lose the weight using regular methods instead of the surgery. I don't have luck with diets so there is no way I will loss weight. It may be different for me because of the way i look and my body figure. Did you have to do an information siminair before you started the process? And as far as medicaid is concerned I have heard that even though it is medicaid eah plan is different (because medicaid lets you pick provider) so my process may be different.
I guess I worded that wrong.
As long as you don't gain a significant amount of weight during those six months, they're happy.
Yes, you do have to meet with your surgeon during the process. The way my surgeon does it is he has several pre-op patients come in on a certain day for a couple of hours. He talked to the whole group, going over all of the surgeries (lap-band, DS and RNY) then briefly went over some nutrition information. Then he answered questions then everyone met with him one on one for about fifteen minutes.
After that, pre-op tests were schedule as well as a one on one meeting with the nutritionist.
Your process may be kind of different, but I was under the impression that in PA, Medicaid's various plans don't differ much when it comes to WLS. I'm sure a few things are going to be different for you, though, as far as the order you have to go through the process and tests that will be required of you.
I had to do the nutritionist appointment, a psych evaluation, attend a WLS support group a few times with documentation to show that I went, an EKG, a chest x-ray, a pulmonary function test, blood work, a sleep study, 6 months of consecutive visits with my PCP and then a two week liquid diet leading up to the actual surgery. (I probably left something out - I'm at work and sleep deprived).
Regardless of the doctor you choose (or as you put it, your provider), Medicaid still requires the same process regarding WLS - I compared notes with other people at support groups from Erie and surrounding cities and also friends in Philadelphia, Pittsburgh and Harrisburg who have had the surgery.
If you aren't certain what they're going to require, you can always call always ask Medicaid directly. I have a PCP who had been through the process with several other patients so I had great guidance.
As long as you don't gain a significant amount of weight during those six months, they're happy.
Yes, you do have to meet with your surgeon during the process. The way my surgeon does it is he has several pre-op patients come in on a certain day for a couple of hours. He talked to the whole group, going over all of the surgeries (lap-band, DS and RNY) then briefly went over some nutrition information. Then he answered questions then everyone met with him one on one for about fifteen minutes.
After that, pre-op tests were schedule as well as a one on one meeting with the nutritionist.
Your process may be kind of different, but I was under the impression that in PA, Medicaid's various plans don't differ much when it comes to WLS. I'm sure a few things are going to be different for you, though, as far as the order you have to go through the process and tests that will be required of you.
I had to do the nutritionist appointment, a psych evaluation, attend a WLS support group a few times with documentation to show that I went, an EKG, a chest x-ray, a pulmonary function test, blood work, a sleep study, 6 months of consecutive visits with my PCP and then a two week liquid diet leading up to the actual surgery. (I probably left something out - I'm at work and sleep deprived).
Regardless of the doctor you choose (or as you put it, your provider), Medicaid still requires the same process regarding WLS - I compared notes with other people at support groups from Erie and surrounding cities and also friends in Philadelphia, Pittsburgh and Harrisburg who have had the surgery.
If you aren't certain what they're going to require, you can always call always ask Medicaid directly. I have a PCP who had been through the process with several other patients so I had great guidance.
Proud mama of Mischa and Gabriel, both born post-op.
I just began this journey myself and hopefully I am looking at wls sometime in late March or April. I along with my surgeon have decided on the lap band procedure. I am border-line and could elect either by pass or lap band but he pointed out that if I lost 65lbs I would be below 200 and my lifestyle would improve immensely which sounds wonderful to me!.
The reason I am replying to your post is that I was told to lose some weight before my surgery just to prove that I can follow a diet plan I will be meeting with a nurtionist next week to go over things, The Dr said if I could lose 10-12lbs that it would be great but even as little as 5 would be fine. Good luck with your decission
The reason I am replying to your post is that I was told to lose some weight before my surgery just to prove that I can follow a diet plan I will be meeting with a nurtionist next week to go over things, The Dr said if I could lose 10-12lbs that it would be great but even as little as 5 would be fine. Good luck with your decission
Thanks for the information. I was going to see my doctor about starting the process. Medcaid or my "provider" unison told me to see my doctor and tell him to send over some paper work saying I need this surgery and it can help me. I have no problem with all those tests (since medicaid will most likely pay 100 % of everything because I am extremely low income) just the visits to surgeon which medicaid will havee to pay for transportation since I have no vehicle
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