Medicaid

You apply at the welfare office in your state.  How to qualify varies a bit from state to state but in most states you have to have young children, be a child yourself (sometimes children qualify but their parents don't), elderly or disabled AND you must meet income guidelines.  It's basically for poor people that aren't able to get a job that provides decent insurance.

I have Medicaid currently. Hopefully this will be approved.

They make you pick a plan but it is backed my Medicaid.

Rachel,

I felt the same way when I started this journey. I live in New York State and my surgery is approved through Medicaid. This is the truth for most states. I was afraid to call my insurance and ask, but the lady was very nice and helpful. My surgery is scheduled for June 23rd. This surgery has become so common. Call to ask your insurance company. You will feel much better moving forward with the answer under your belt. I did!

You are right! I need to sit down and call my Insurance company. I guess I am just afraid of the answers. I have been let down alot. I was just wondering if anyone in Ohio has had luck or if there were alot hurdles that had to be jumped.

I have both Medicare and Ohio Medicaid.  Medicare is my primary insurance, so they paid 80% of my WLS.  Medicaid paid the rest (after I paid my $450 spend down).  I did not have to jump through many hoops at all.  But your Medicaid plan may be different than mine, or maybe the rules have changed in the five years since my surgery, or maybe it's different if Medicaid is your primary instead of secondary.  The only way to know is to call and ask.

I have Medicaid and they cover my surgery as long as it's medically necessary.  I have Paramount Advantage. But I have not seen the surgeon yet so they have not sent approval in yet.

I do not think that my PCP thinks it is medically necessary. I have to have a referral from her which I am not sure I can even get. Who decides if it is medically necessary? The weight loss center or my PCP?

Usually your PCP.  There is a list of comorbidity which Medicaid told me I had to have for it to be medically necessary.  But call your insurance company and ask. 

If your PCP refuses to give you a referral, find a new PCP.

The weight loss center will not operate on you if they do not think it is medically necessary.

Your PCP will probably not give you a referral if they do not think it is medically necessary.

Your insurance will not pay for surgery if they do not think it is medically necessary.

So each of those will decide if they think it is medically  necessary or not.