Has anyone delt with Medicaid recently for WLS.  After I have started the WLS program I am now told that they believe my insurance is going to require a 6 month dr supervised diet plan.  I have tried contacted medicaid several times with no luck.  NO one knows what I am talking about.  The WLS Center said they that lately they have been getting feed back on some patients some requesting the 6 month diet and some just want 3 year showing obesity and others coming back with no problems at all. They said Mainecare is very unpredicable right now and they want to play it safe.  My PCP is not impressed about this at all she says it is a waste of time and money and nothing but a big hold up.  She said why cant I just write a letter.  I said because they said they are requiring a 6 month diet to be in the safe side. My PCP had a point and her point was ok lets start the diet appointments but in the mean time get everything else done and then have them submit to insurance if it comes back that you need to continue on with the 6 months then we continue.  She said I dont want to get to the end of your 6 months and then they deny you or want something else.  Anyone out there have this happen to you?

what is pre-certification paper work and when does it get submitted, just wondering saw someone else's posted that they submitted it

Besides the BMI requirement I also have the out of network obstacle.
CONGRATS on your referral!!! It's AWESOME that a RNY surgeon suggested the DS and wrote a recomendation for it! I think that's unheard of.

I posted this on the VSG forum.   But thought this would also be helpful to put on the insurance forum.

Hello VSGers...

If you are a Fed employee it is open enrollment time.

Well I currently have FEP BCBS and began my process in August to consider surgery for early 2011.  Well since it is open enrollment, I wanted to review the changes to the plan (of course I am mainly interested in the changes regarding WLS and some others).

Well there are some changes, mainly they are  requiring a 3-month  participation in a medically supervised weight loss program, including nutritional counseling begining in January 2011

So those that are looking to have surgery early next year, please be advised of the new requirements.  They can be found on page 53 of the Blue Cross Blue Shield Services Benefit Plan. Go to your HR office or find it on-line at www.fepblue.org.


Just thought I would share...
If you have additional information please share with other FEB BCBS VSGers.

Have a good day!

The fact that your PCP has provided a referral is a good thing -- that means the PCP supports the idea.   

The surgeon will need to submit for final approval from the insurance company and most likely will need to obtain some history from your PCP.

Good luck.....