Will somebody out there "H-E-L-P ma" pleazzzz!!!

LOL! Geesh, I cannot for the life of me find out where to get information about MY so called "insurance" to see if, and, weather-or-not, they cover the kind of surgery I want, (or at best, what I can get!). Here's the scoop! I am on Social Security/Disability and full Medicade coverage. (*arugh*, rolling eyes too) Now, here's the deal, my BMI is like 47, so no problem there for qualifying! (Infact, I've been through all the pre-tests and etc.'s several years back already) What I'd like, moreover have to have, is the Lap. Ry. Problem is, I WANTED IT 4YRS AGO!!! But now literally have a team of Dr's on my side ready and waiting to do battle for me to get this done ~ Soooo, where do I start??

well, first you should have the surgeon's office submit the pre-authorization. if the ins covers it they will let you know... or they'll ask you to submit additional information they need. good luck.

Terri I'm kinda in the sorta same boat. SSI medicaid and doc on my side. main diif is I want the DS and it needs to be a reision and no docs here in MI will accept the medicaid. So.on I wait. But what you need to do is directly contact your HMO for your medicaid and find out for sure if they cover it..and I'm sure they will tell you if it's medically necessary and what you must submit such as documentation of your weight and for how long ..... any weight loss attempts supervised by your doc..... most likely all the testing will have to be done over if more than 6 months since done...... and any co-morbidities you may have to help your case..... the HMO has to tell you this needed info. ANd when you have what is needed in writing(don't give them wiggle room on what is needed) then you can get the help of your PCP and get the ball rlling downhill instead of uphill in a strong wind. BEST WISHES

Here is a suggestion. If you are on SS Disability I presume that you have medicare along with your medicaid. If you do medicare covers the surgery if it is medically necessary. I know where you can find the requirements for medicare if you live in OH so e-mail me and I will give you instructions on where to go to get the requirements. That may give you some insite on what you need, even if you do not live in OH it should still give an idea of what medicare requires. Shelia [email protected]

Try calling your local SS office. They should be able to give you a phone number where you can call Medicare. Make sure you tell them you want to talk to a person not an automated system. Before you call, check with your provider and get the CPT code. That is the code that Medicare will use to look up the procedure to see if it is covered. Don't worry your dr's office will know what CPT is. Good Luck Gail Thresher.