Medicaid

Has anyone been approved for this surgery with Medicaid? I am afraid that I am going to just be let down. The  weight loss clinic  called and said that they needed a referral from my doctor before I can proceed. I am hoping that my doctor with give the referral I need. But once I get the referral, I havin a feeling that it will just lead to a dead end. Any info that anyone could provide? My insurance is backed my Medicaid but my plan is through the United Healthcare Community of Ohio. Any help would be great! Thanks!

I live in CT, and have Medicaid. My surgeons office has no problems getting approval for people with Medicaid. So I don't think you'll have any issues. Good luck!!! 

Did they make you prove that it was medically necessary?

Yes. I was required to have a bmi of over 40 or a lower bmi with 2 comorbidities. I have a bmi that is over 40 so they would approve based on that. I also have a few minor problems associated with my weight. They also request that I take 6 months of nutrition classes. I'm sure every state is different though. You can call them and verify. My surgon actually asked that I verify with my insurance before I complete any of my appointments. 

Were there certain requirements that you had to complete before hand? Like a diet for 6 months?

The surgeons office requires monthly weigh ins for the 6 months. They then send that information to the insurance. I was never told that I HAD to lose weight before it was submitted to insurance, however, I feel that it can only help in the approval process. I want to show the insurance that I am committed and don't want to give them any reason to deny me. 

Well I have officially gotten my referral from my doctor and I have been accepted into the Kings Daughters WLP. The lady said that my surgery is not guaranteed. I guess I am still at risk for my Medicaid to not cover the surgeon. I am trying to stay positive in the fact that surely if my insurance was not going to pay for the surgeon then surely they would not have allowed me to start this program. I thought that I was going to have to have 2 co-morbities but my BMI alone qualified me for the program. My first appt is July 21, 2014. I am hoping that this is the start to something great!

Congratulations!  I think you will be fine. Insurance has a cheaper time paying to get you healthy via surgery than them paying for a lifetime of meds and doctors appointments because you are obese. My case is with insurance now, I have my fingers crossed that my approval comes back soon!!! Keep me updated on how you're doing. Best of luck!

Call the insurance company, ask if they cover WLS and if so, what their requirements are.  If you meet their requirements, they will pay for your surgery.

How do you get Medicaid? I have an indvidual plan..