OSU Consult & Medicaid

I am a patient @ the OSU WLS Program and I am waiting for approval from Medicaid. I am currently participating in nutrition classes with only two remaining. I received a letter informing me that my consultation with Dr. Cook is on the 23rd of September. The letter also requested that I have a refferal from my pcp prior to this appointment and get prior authorization from my insurance (which is Medicaid). Here are my questions: 1. Would the letters and referrals sent to OSU by my pcp surfice or do I have to get another referral for consultation? 2. How do I know if Medicaid will pay for my consultation if I still waiting for approval for the RNY? 3. Should I be safe and delay consultation until I am sure Medicaid has approved me? Has anyone had this situation before and if so how was it handled. I had to scrap to pay out of pocket for MedGem reading ($50) and nutritional classes.($95). I will contact Dr. Cook's office, I'm just curious to get information before I call. Thank you for any comments or suggestions. Georgeann

I don't have an answer for you, but my Approval came in my PCP's name and had to be sent back to them to have the surgeons name changed on it. However the surgeons office went ahead and scheduled my consult and 1st with dietician... so ? 1) I think probably so though as the surgeon is a specialist and you have your pcp's referral 2) dunno.. 3) not a chance... if OSU has scheduled you, go for it. I don't think you need pre-approval for Medicare As I said though I am not for sure on any of this info.. don't hold me to it

Hey Vickie, On your profile you said that Medicaid will cover the surgery, but they do not cover the surgeon's fee. Did you find a surgeon that accepts Medicaid yet. Also I have Mediacid and Medicare (HOSPITALIZATION ONLY). I will call OSU on Monday ... Thanks and hang in there! Georgeann

Yes, I'm going with Dr. Curry in Cincinnati. I'm approved and my consult is this coming Friday!

Congratulations ... and best wishes! Georgeann

Have you talked to Kathy Horton at OSU? She handles all of the insurance/certification issues for all of OSU's WLS patients. She deals with all kinds of insurance companies and I'm sure she's had some experience with Medicaid too. She helped me immensely in coordinating the timing of the whole insurance process with the OSU process. If you don't have her phone number, send me an email and I can get it to you. Good luck!

Thank you for the information Diana. I will contact her on Monday with my questions ... I was just curious to find out something before I called. Congratulations on your progress! Georgeann

I had surgery with Dr. Cook at OSU with Medicaid. I was told by OSU that I needed to get prior authorization from Medicaid before they would even look at my application. My PCP wrote a letter to the Medicaid office and I was approved in 2 months. Medicaid covered all my pre-op stuff...nutrition classes and tests. I had my psych test done at my campus counseling center. They weren't doing MedGym at the time...and since I did pay out of pocket for it...but that's just because I didn't even try to see if Medicaid would cover it. You might be able to have your PCP call the number on the back of your medicaid card to find out what has to be done now to get prior auth.