Medicaid Maze

RachaelThomas
on 7/22/14 10:08 pm - South Point, OH
VSG on 12/17/14

Oh yes, the Medicaid Maze. I am currently dealing with this. I decided to contact a WLP in Ky. They informed that they would accept my insurance BUT I needed a referral from my PCP. I obtained the referral and was able to start the program.. HOWEVER we are treading in murky water. The insurance company can not give clear answers on what is required to me or the WLP. SO I am going to continue until I can't go any further. I met with a Dietitian, a nurse, and had my psyc eval. I meet with the surgeon next month to see what he is going to require me to do ( the nurse said she doesnt think I will have to do the sleep study BUT they are gonna wanna run a scope down my throat since I do have severe acid reflux).  I also will be attending some support group classes. We decided to go ahead and start the 6 month diet just incase they decide that they want me to do that. In the whole waiting process I would already have a month + under my belt if required so it only makes sense. I am going to go ahead and do all the requirements on the WLP's end and then they will be submitting all of my information and progress to my insurance hoping that I will be able to get the approval for the surgeon. I think that my insurance will require me to complete is a 6 month diet and I am totally ok with that. BUT this is Medicaid and I could get denied alltogether. I was told by a nurse at my PCP's office that in order to get this surgery you have to be very ill. I am not diabetic nor do I suffer from any comorbities however my BMI is 43. I am trying to stay positive because of having no clear answers from anyone. Even the nurse at the WLP told me that this is all new and that they have never dealt with Medicaid plans before. I will not give up EVEN if I am denied. I try to remember to go one day at a time and have faith that everything will happen for me in due time. 

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