Medicaid & Revisions

Does Medicaid pay for revisions?

Would love to hear from anyone who has any experience w/ this insurance. When I contacted them they said they pay for anything medically necessary.

Katrina

                                                                                  YES.

medicare and medicadi togehter or separately will pay.

i called and talked with them myself about my own situation. they will pay when medically necessary. if you are bmi 35 or more with comorbidities such as hypertension, sleep apnea, degenerative joints, etc.

i didn't beleive i had sleep apnea. recently the doctor requested i be tested. i was truly surprised to find out i did. And not only that i did have it but it was severe. Now i use a machine. so get tested. it is more of a common problem than most people think.

Good luck. There is hope for people with medicaid.

 are you only two years out from a rny? are you looking at revision surgery after your rny  two years ago? 

Your post gives me so much hope.
I have been worrying myself to death about whether or not Medicaid will pay for my revision.
I am a little over 2 years out now. I want a revision to a DS because with my RNY I only lost 102 lbs from day of surgery. I stopped losing at 9 months out. I have put back on 47 lbs, and my BMI is nearly 40.. it's like 39.4. I no longer feel restriction and I have frequent acid reflux. I've been researching the DS and it seems like it will be the surgery to keep the weight off long term. I was so thankful to lose those 100 lbs. It totally changed my life. I cannot put into words how discouraging it was to see the scale rise.
I am hoping to talk to the insurance coordinator on Monday and see what she has to say.. I posted this question all over OH. I just prayed hard someone could give me answers. Thank you so much for all your replies.

Thank you,
Katrina

Each state is different, you need to contact your state and find out what you have to do to qualify.  I didn't know Medicaid paid for DS but then I don't know much about Medicaid.

Hello and Thank you for your reply.
I did actually contact Medicaid on Friday 9/26. I had the Insurance code for DS and she said it was in their system. She sounded negative though once she found out it had paid for my RNY. She seemed skeptical about them paying for the DS even with a mechanical failure or other problem since it paid for my RNY. This may be a lost cause for all I know. I pray to have good positive news on Monday when I speak with the insurance lady. It would be awful to pay for a surgical consult to find out insurance doesn't cover the procedure.

I'm not the most diplomatic person and I swear I don't intend for some things to sound after I type them but I have to ask.  According to your profile Medicaid paid for your RNY and you aren't following any of the rules.  Food quantity, food type, exercise, etc.  You know, there are rules with DS too.  If you eat the same foods that you are now you will smell a bit like a sewer.   They have huge issues with gas, leaking oil rectally, the smell is pretty horrific when consuming carbs.  Are you going to be able to give up bad carbs with DS anymore than you can with RNY?

I mean, your problem does not sound like a mechanical failure, it sounds like you aren't following the rules for WLS.

if the insurance coverred your surgery the first time it will definitely pay the second time. i spoke with them about that too. telling them i had a rny 12 years ago and thier answer was YES. the reason being that the second surgery is considered an extention of the first. the same problem that was approved the first time still exists. but again, the insurance only pays if there are medical problems associated with it.

are you hyper tensive, do you have sleep apnea, diabests, or you at risk of having those things. your doctor will know. or should anyway.

YES the second surgery is covered. but why did you regain the weight so soon after? that concerns me. you say you think a ds is better and will keep you slender. Your wording i think says it all.

The surgery does not make you slender. NO NO NO. it helps you with your dieting. it is restrictive. meaing it makes your stomach small but if you still keep putting fattening foods in it won't be so useful and won't work in the long run.

before having the second surgery they are going to want to know if you have tried to lose the regained weight yourself and failed. and if so why did you fail. the reason they ask is because the surgery does not make you slender. the surgery helps you make you slender. don't look to the surgery as the whole answer. it is only meant to help you help yourself.

now stop worring for today and go outside and play. i am fat but i got to a nude beach and have fun. so go have fun in spite of your high bmi. open up. don't keep it all to yourself.

We disagree on one point.  Saying that insurance will certainly cover a revision is not accurate.  Policies change, rules change, requirements change.  Some states will ONLY pay for banding or bypass, not sleeves or DS.

I just had someone PM me for help getting her surgey approved through Medicaid, she's in TN and she claims TN Medicaid just changed all their rules and they do not cover WLS anymore.  I have not verified that, it's just what she told me.  I don't know much about Medicaid so I'm not a lot of help to her.

When it comes to insurance or Medicaid, nothing is certain.  What happens in one state is not necessarily what will happen in another state.

I do fully agree with you about how people look at WLS.  It's not the surgery that gets us thin or maintains a thin body, it's a tool we use to get there.  I know one person that started off with a band, she gained with a band.  She revised to a sleeve, she gained again with a sleeve.  I'm talking pre surgery weight, not a regain of lost weight.  Now she just revised to RNY.  I fully expect her to lose with RNY and then she'll regain after the honeymoon phase.  I hope I'm wrong but I don't think I am. :o(

I believe I will first have to do a Upper GI test and possible an endoscopy so they can further check my pouch out.. Their may not even be a problem with those areas, we shall see. I stopped losing weight at 9 months post op.  I never said DS will keep me slender. I never once said that I want to be slender. My goal weight is 180 lbs, to me that is still overweight for a person that is 5'6. My #1 concern is gaining those health problems back.. hypertension, sleep apnea, high cholesterol, back/joint pains(already there), etc. My ultimate goal is to be healthy. Maybe my body is just comfortable at 200 lbs, who knows? If I could get there and stay there I'd be 100% happy. I think that was part of my problem in the beginning, I relied on my tool alone.
I wish I could go outside LOL. I am stuck indoors at work.

Thank You.