Medicaid/Badgercare question??

If anyone knows what the restrictions from medicaid/badgercare are, could you please let me know. I have been hearing comflicting answers. A surgeon's office in LaCrosse says that they require you to attend a nutrition clinic for 6 months before being considered. When I called the Medicaid office, one person said she never heard of that. Another call to someone else said that your weight had to be life threatening. I would really appreciate any feedback. Cindy

Hey Cindy, With the whole Badgercare and Medical Assistance thing it depends if you have strait T-19 or Bagdercare or which of many HMO's that Medical Assistance hires out. I have Managed Health HMO through MA. For mine, a psych eval is absolutely necessary. Guidelines are established for different weight ranges and different groups of "Co-Morbidities." Your BMI needs to be above 40 (I think); but if you have other fat-induced problems such as GERD, diabetis, hypertension, major clinical depression, and stuff like that, you could be OKed for surgery with a BMI as low as 30. It just depends on what the specific insurance you have through the state. I know I have to see a dietician, but not forever. It would help too if you have tried many weightloss programs, had no success or success that did not stick. Call the number on the forward card. The will check which program you are in and give you another number. Make sure you are speaking to the right people when you ask the questions. That would be the second 800 number you dial. Good luck. S

Hi there! This is the first time I have posted. I work for a prominant surgeon in the cities as a medical administrative assistant , therefore I work with the insurance companies first hand. I can tell you that not only is the nutrition clinic required but in order for your surgery to be approved you must have been diagnosed with Sleep Apnea or it is an automatic denial of benefits. This I know for fact. If you are diagnosed with OSA(obstructive sleep apnea) you usually get approved right away without the nutrititon clinc. Just so you all know, I am not lurking here. I had surgery on April 27. A RNY Open Gastric bypass. I may have worked with patients for over 3 years but now I am on the other side as a patient. I hope the information that I can provide for you and others will help to make your journey to better health a great success! Time to take a walk. Anybody else have questions feel free to ask. I will answer with the best of my ability.