I am NEW and starting the process on MEDICAID.. LOOKING for FRIENDS

Hello everyone. I am a 30yr old mom of 3 in Columbia, SC. I am just starting the process for gastric bypass and would REALLY like some help as to what to look forward to and how to go about getting approval.. I would LOVE to talk to some of you others out there that have SC Medicaid. I am so SCARED of being turned down, but I see lots of you guys have approvals.. I am sure with my weight it shouldn't be a problem, but, I want it done NOW! Thanks for all of you that can help guide me.

Carroll
[email protected]

Hey Carroll.

I wouldn't hold my breath waiting for replies here. It takes a while to get a reply or two, coz it doesn't seem like this forum gets used all that much. Although it does seem to have picked up a little bit lately. Anyway, I guess I'm just trying to say, don't get too disappointed if you don't get a reply on here for a few days.

Now, as for the rest of your post, since you're in Columbia, I can't really recommend a doctor, unless you're willing to take a trip to Spartanburg. Dr. Ross is a professional *****ally goes out of his way to care for and treat his patients. Now as far as what you'll have to do, (I'm assuming you haven't even started the process, yet) first, you'll have to find a doctor in your area that accepts Medicaid. I'd ask around first, because you might run across a Dr. that accepts Medicaid, but they'll want an extra $2000 for a bunch of other stuff that in my opinion, really isn't necessary, and to be truthful, who the hell can afford $2000 if you're on Medicaid?? The reason I say you should ask around is because whatever Dr. you choose, you're going to have to sit through a 2-3 hour long seminar, and they won't tell you about the extra $2000 charge until the very end of the seminar. Then, when you find a Dr. that doesn't charge the extra fee, you'll have to sit through that Dr's seminar, too.

Once the seminar is over, you'll have to fill out some paperwork and then a couple of weeks later, you'll get to see someone in the Dr's staff who will guide you through some more of the process and have you fill out some more paperwork. There you'll find out that you'll need a 2 year statement from your family doc and Medicaid requires a 6 week (or 6 month, but I'm pretty sure, it's 6 weeks) physisian supervised weight loss regiment. I was able to bypass this requirement, becaue of my problems with my back. Once you get all that, you'll have to have a phyciatric evaluation. (Why, I don't know. This still baffles me - It's just a bunch of questions that your family doctor should be able to answer, but it has to be performed by a phsych.) That can cost anywhere from $100 - $250, unless you can luck up and find one that accepts medicaid, if your surgeon will approve it. (Some of them require you to go through their preapproved psychs.) Them, once you get that evaluation done, and they turn it in to your surgeon, they'll run your file through a comittee, and once they approve it, you'll just have to wait for Medicaid to approve it. And finally, depending on how high your BMI is, you'll have to have at least 2 other weight related things wrong with you - chronic pain, problems with your knees, etc., depression, back pain, etc.

I was worried about not getting approved, too, but I eventually was. I had my surgery 2 weeks ago, tomorrow and  I only had minor problems since then. So if you need to talk or ask anything, just send me a message and I'll get back to you as soon as I can.

Chris

Carroll,
Chris pretty much sumed it up. I can tell you if you could travel to Myrtle Beach for the procedure that Dr. Balder is the bomb. His staff knows their stuff and the information packet they give at the first 1 hour seminar has all of the forms and explains every thing in clear terms. From the day I went to the seminar to the day of surgery was almost eight weeks. The office does charge $300 that is non-refundable and medicaid does not cover. A psychiatrist letter is $175, your first three months of vitamins are about $120 and protein is about $30-$70 depending on what and where you get it. As soon as I got my packet I filled out every thing and made back up copies, I paid the $300 dr fee, I contacted my general dr for his letter and scheduled my shrink eval. If you are serious this is the course you will need to take. If you have ever followed a weight loss regimin (and we all have) you need to list them so you will have them (this is important if you do not have any other issues) I followed weigh****chers, did the rice diet, Atkins, slim fast, Zonegran, Zenical, Myrtle beach diet... you get the point. I always checked with my doctor before starting a program or regimin so that he had to document it. I have known for 6 years that I would end up with WLS of some sort. I chose Roux-en-y.
Good luck and don't get discouraged it is a process and takes time.
Tammie

Yes...Dr. Balder is DA BOMB!!!!!

HEY I BEEN WONDERING IF YOU HAD YOUR SURGERY AND  WHAT ALL IS GOING ON  HOW DID IT GO  CONGRATS BY THE WAY   I  HAD SURGERY ON THE 4TH TO HAVE MY FILTER INSERTED AND I GO TOMORRO FOR THE PRE UP BLOOD WORK AND THE CLASS AS WELL  ANY PROBLEMS DO YOU KNOW IF YOU LOST ANY YET CONGRATS CHRIS? I DUNNO WHY THEY PUT MY RESPONSE UNDER SOMEONE ELSE LOLLOL

Hi Carroll,

I had my surgery in Columbia.  I don't know about medicaid because I was self pay but Dr Glen Strickland was my doctor and I loved him.

If you post on the VSG board you will probably get more responses.
 

Good Luck

Rita

 

Hey Carroll,

I'm not in Columbia, but I'm over in Sumter! Nor do I have Medicade, but I wanted to say hello - and welcome you!  I'm 30 years old, with two boys - ages 6 1/2 and almost 5. I had my surgery when we still lived in WA state (near Seattle), and am just over a year out now.  This has been a FANTASTIC journey for me!  Please let me know if you have any questions.  I go to Columbia once in a while...maybe we can get together sometime!  And if you ever head over this way to Sumter (yeah, I know - for what right? LOL)...

I have medicaid. It depends on the medicaid plan you choose. Mine was First Choice by Select Health of SC. They approved me the very first try and in about a week.

Hello . my name is michael 28  rock hill sc.  im in process of trying to disablity and medicaid /medicare whats it called, thats a pain in the rear. I was also seeing if medicaid or medicare pays for weight loss surgery. most docters want insurance well i have no insurance cause i cant work. not sure what else to say im not that good at writing, so if im rambling along sorry.


michael
(Please PM me in you would like)

FIRST OFF, IF ANYONE KNOW ANYONE THAT WILL DO A PSCY. EVAL.. LESS THAN $250   ORTHAT TAKES MEDICAID OR A SLIDING FEE SCALE LET ME KNOW... THAT IS MY NEXT STEP...

HI EVERYONE! I am so so so sorry I have not been on here in a LONG TIME.. but, I have a update...

After my seminar, I was required to complete 6 months of DR. SUPERVISED weight management.. my 6 month visit was this week, on Sept. 9th... 

Let me back track a little.. I have am seeing Dr. Paul Ross in Spartanburg. That is 2 hrs. north of me but the ONLY Doctor I could find that took MEDICAID without any weird rules like Palmetto Baptist had.. Palmetto Baptist, here in Columbia, ONLY TAKES 1 MEDICAID PATIENT A MONTH, on top of that, there is a $2000 FEE as well.. DR. ROSS does not require ANY FEES, however, you do have to have a psyc. evaluation and I have not been able to find ANYONE that takes MEDICAID for that, so, I am going with the one they refered me too.. he ALSO will email or snail mail you the forms to fill out, you can SCAN OR SNAIL MAIL them back, and he charges a $250 fee, however, that is better than palmetto's $2000.. ok, so now I am going to list the REQUIREMENTS for DR. ROSS...

Our Program - DR. PAUL ROSS , SPARTANBURG SC

Thank you for inquiring about our program. We are anxious to work with you to help you attain your weight loss goals. Because we want you to be healthy and have a positive outcome, below is more information so you can learn more about our program and its requirements.

1. The first step is to call Regional Surgical Weight Loss at 864-560-6935 to register for the free informational session. This class is required to help you understand the procedure and what to expect after surgery.

2. Call your insurance carrier to verify coverage for weight loss surgery.

3. Complete the information packet you receive at the seminar, including diet and exercise history.

4. Acquire documentation

a. Supervised weight loss attempts: Our program requires six consecutive weeks of physician supervised weight loss in the past two years.
NOTE: Your insurance may have a longer time requirement for supervised weight loss. If your insurance requires more time, you must follow their requirement.

b. Letter of support from your primary care physician: We require a letter from your primary care physician outlining how your weight is affecting your health and what you and your physician have done to address this issue. We also require two years of office notes that support the information in the letter of support from your primary care physician.

5. Call 864-560-7533 to make a follow up appointment.

6. You will receive an appointment for a psychological evaluation. Your nutrition information will be reviewed by a registered dietitian.

7. When these evaluations are complete, you will receive an appointment to see a surgeon.

8. If you are accepted as a weight loss surgery patient, the surgeon will submit your information to your insurance carrier for authorization.

9. Once authorization is received, your surgery will be scheduled.



_____________________________________________________________________

Now, I am to step..#7....   I went to my last appointment with my primary care Dr. on 9/8/09.. I called Dr. Ross's office and they got me in the NEXT DAY, 9/9/09 to meet with NORMA to go over all my records.. Norma then called the pscy. she has, and he called me within a hour! He then emailed me ALL my paperwork, which I filled out, now all I have to do is SCAN or SNAIL MAIL that back to him with the $250 fee and he will then conduct a 1 hour telephone consult! How awesome is that, I don't even have to go anywhere.. he will then submit his letter to Dr. Ross...so, Norma told me that NC MEDICAID is harder to deal with then SC MEDICAID, which made me feel good.. SO FAR, things have gone SO SMOOTHLY.. it really depends on insurance now.. hopefully I will get someone nice the nurse said, that will go ahead and approve me.. I hope that my BMI, along with my blood pressure, my arthritis and other issues that will push them to give me the ok.. the nurse said it really depends on the person that gets my case at insurance.. so we will see.. ok, I am on step 7...she said the beginning of OCT. the Dr. has a meeting, they then will set me up to see Dr. Ross, he will then submit my letter of medical nesscity to MEDICAID and then we WAIT.. HOPEFULLY like I said before, I get someone nice, who isn't back logged and I get approved right away, if that is the case, EARLIEST I could have surgery is NOV. it looks like.. but that is if everything goes by like SNAP SNAP SNAP.. it really is going to depend on MEDICAID.. so ... here is to hoping that I get someone nice, someone who isn't backlogged and REALLY wants to help me! I hope this helps some of you out there. I know it has been SUPER hard for me to find ANY INFO on other people in SC with MEDICAID, so I hope I have helped others of you out there... I would LOVE to hear from some of you that have been though this with MEDICAID or that are GOING through this now...