Medicaid/LapBand

Can someone here help point me in the right direction to find out if medicaid covers the band I know medicare has started covering it but i cannot find if medicaid covers it. I am not sure where to look. Any help would be greatly appreciated thanks KB

i had medicaid and had an rny lap,,,im sure it would cover it,,,,,call musc, sandy

thanks sandy but I am talking about the Lap Band not RNY that is not for me thanks again though for the response.

If an insurance company or government agency is going to cover this kind of surgery, they usually cover all the different types of surgery ... So, you're actually looking to see if Mdicare covers weight loss surgery, then Lap Band in particular. If they cover RNY like Ms Sandy said, they most probably cover the Lap Band procedure or any of the other procedures done for the purpose of permanent weight loss. So, the fact that Medicare covered RNY is good news as it indicates that Lap Bands will probably be covered as well. There is a forum here on the board just for Lap Banders ... Have you checked out that board? You may find more info there! GOOD LUCK! God bless you ... Dawn & Nick

call dr bour in simpsonville (bariatric solutions) or dr. ross in spartanburg. charleston is bit far from you!!

I cannot believe that South Carolina Medicaid does not cover the lapband, I called today and they told me that medicaid does not cover the band when asked if there was a written exclusion she said that a dr would have to call and ask that question. So once again I am bummed out, b/c i can afford the surgery at this point, or any insurance that would cover it, and bypass isnt an option for me. Thanks to everyone for your help. KB

OK ... HERE'S A LITTLE TRICK THAT SOME INSURANCE COMPANIES USE TO GET OUT OF ACKNOWLEDGING THAT THEY DO COVER CERTAIN PROCEDURES ... IT MAY BE AN ISSUE SINCE THEY GAVE YOU SOME DOUBLE TALK ABOUT THE DOCTOR HAVING TO ASK ABOUT THE EXCLUSION ... YOU NEED TO ASK, "DOES MEDICAID COVER MEDICALLY-NECESSARY WEIGHT LOSS OR LAB BAND SURGERY?" BE SURE YOU USE THE WORDS "MEDICALLY-NECESSARY" IN YOUR QUESTION. IF THE ANSWER IS STILL "NO", ASK TO SEE THEIR WRITTEN GUIDELINES & EXCLUSIONS. THEY MUST GIVE YOU THOSE. ALSO, YOU CAN CALL ANY GASTRIC BYPASS PRACTICE OR SET UP AN INITIAL APPOINTMENT & SPEAK WITH THEIR FINANCIAL/INSURANCE REPRESPENTATIVE & THEY SHOULD KNOW FOR SURE IF MEDICAID COVERS "MEDICALLY-NECESSARY" WEIGHT LOSS SURGICAL PROCEDURES & WHICH ONES THEY COVER. THE ONLY THING YOU NEED TO PROVE MEDICAL-NECESSITY IS A BMI OVER 40.0 ... AT LEAST 100 #s OVERWEIGHT ... &/OR 1 OR MORE CO-MORBS. IF YOU HAVE SEVERAL MAJOR CO-MORBS, SOME INSURERS WILL ACCEPT LOWER BMIs & LESS POUNDAGE. DON'T GIVE UP YET ... IT DOESN'T SOUND LIKE YOU REALLY HAVE AN ANSWER ... IT SOUNDS LIKE THEY JUST BLEW YOU OFF. GOD BLESS YOU KB ... DAWN & NICK

I am new to the whole medicaid deal, even though its an ins provided by the government they still have to give me their written guidelines and approvals? My BMI is 39.5 i have sleep apnea,depression, and I am exactly 115lbs overweight so i think i have all the medical problems as i was approved by a doctor last year but was self pay b/c my insurance at the time was BCBSNC and through COBRA had a written exclusion so i was out of luck. I do know that SC medicaid will cover the gastric bypass so it jsut doesnt make sense to me not to cover a surgery that is less risky but i will keep trying. thanks for the advice and please keep me in your prayers that a door way will open and that hopefully i will be banded. KB

Well, I am flyin' by the seat of my pants on Medicaid cuz I know very little about it sooooooooooo, please ... Anyone who has knowledge about Medicaid, please bring some words of wisdom into this ... An Insurance Provider must give you, or have available for you to read, their guidelines & exclusions ... They must be availale to you, the person covered by the insurance ... &, they must be available to your Physicians. This info cannot be withheld from you. They are y-o-u-r benefits. Usually, if an Insurance Provider covers one kind of procedure, they cover all or most procedures within that group of procedures. But, if a certain procedure does not have the success statistics they are looking for, or has high failure statistics, or more related medical problems than other procedures, then they can & will refuse to provide that procedure. That may be why RNY is covered where lap band is not ... Just throwing out a possibility. For example, until 2005, Lap RNY was not covered by TriCare Prime ... they only covered Open RNY. Once Lap became as safe as Open, then safer than Open ... then TriCare Prime began covering Lap RNY as well as Open RNY. Check out the Lap Band Board here on obesityhelp.com ... You may be able to find more info that could help you, KB. God bless you ... Dawn & Nick

Ok so i called back this morning and asked about Medically Necessary weight loss surgery she said the only one medicaid covers is the bypass, they DO NOT cover theband when asked once again about the written guidelines and exclusion she said dr would have to call, hen I asked well i am covered on medicaid is there not anyway tha i can get those, so she transferred me, they said that wasnt the right person, so i got transferred again, then i was told to go to my local case worker, to get those she would print them out, but with the attitude she has i am not sure if i can get them from her.So at this point my family dr who gave me the recommendation last year for surgeyr doesnt take medicaid and i dont have another dr would refer me b/c they havent treated me for my weight problems, i do not know what to do now.