Anyone have Virginia Medicaid? If so, HELP!!

Ok, so I have Virginia Medicaid and I am wanting to have WLS. My doctor also wants me to have it. I have a few questions for anyone who can answer: 1- Did Virginia Medicaid approve your surgery? 2- What did you have to do to get the approval? 3- How long did it take to get the approval? 4- If they did not approve it, why? 5- How long does it take to get an answer one way or another? 6- Do they require a 6 month medically supervised diet? 7- What will they consider an acceptable diet? Meaning WW, Slim Fast, Atkins, etc... 8- Will Virginia Medicaid the Lap-Band? 9- If they do, will they cover the fills, or are they out of pocket expenses? 10- Will Virginia Medicaid cover the VSG (sleeve) or is it considered to new and experimental? 11- Will Virginia Medicaid cover the DS (the Switch)? 12- If they do, will they cover the necessary supplements if your doctor writes a script for them, or are they out of pocket expenses? I'm sorry I'm asking so many questions. I have called and just get a generic answer "Every case is different." But i would think that there are basic guidelines that ALL Medicaid has to follow. I don't know. Can anyone help? Thanks!!

It has been a long time since I had medicaid (13 years ago when I was pregnant and then after I had my daughter) and they denied me even though I met all of the requirements and then some.  I do not know what the requirements are now for them.  As for your supplements, most are over the counter so they are out of pocket and not covered.  I buy in bulk and through the mail to reduce my expenses on them.  A lot of places (walgreens, etc.) have buy one get one sales frequently and I try and get them then.  Good luck! Tammy

Hello, I am new to this board and have not posted here yet but I can tell you my daughter is having WLS on July 9th and medicaid is covering it. When all her paperwork was turned in it took about a week to get approved. All she had to do was follow all the terms from the bariatic's. which was going to 2 support group meetings, psyh eval,  and nut-exercise class. I hope this helped you some. Geri

Virginia Medicaid didnt require the 6 month medically supervised diet? Or had she already done that prior to scheduling the surgery? Which procedure is she having? How long did the approval take? Thanks so much!!

Hi there. Tomorrow I will be 7 weeks post op. I, myself, have Medicare & Medicaid. I, myself, know that they, BOTH, will cover it, provided that you meet their requirements and do what they ask. Let me see if I can answer your ?'s # by #. 1) Medicare paid for it but both, Medicare & Medicaid approved it. 2) meet their requirements, and do the things they asked. 3) this is something that you may have to ask the siurgeon's billing office 4) did approve it. 6) yes they require a 6 month supervised diet, or at least they did 7) i used a diabetic diet, monitored by my diabetic nutrionist and my pcp 8) at the time i became interested, the lap band was not covered but it may have changed.

I would suggest talking with the bariatric coordinator at the surgeon's office that you chose. I remember when I started this process, she was able to give me an informational sheet with tons of insurances listed and all their requirements. I hope that I have helped.

Thank you so much. Thats a huge help. :)

I also had RNY surgery done in march with medicaide, and medicare both had to be approved, I had to go on a six month supervised diet with my pcp who kept a log of my weight each month and has me see a nutritionist to get me on my way to healthy eating and just followed me from there.AT the end of the six months, he just turns in reports and that was that.They don't care if you go to WW or JC or ATKINS or any of the expensive weight loss facilities, all you need is your doctors report saying that he supervised your diet.It's a piece of cake, and you will be over this hurtle in know time. It only took about 10 days for my approval after it was submitted. Best of luck.Pam

One thing I forgot to mention is that with Medicare (and maybe with Medicaid as well) they DO NOT do pre authorizations for ANY WLS surgery. You have to complete their requirements, have the surgery and then the surgeon submits for payment. It can take a while for approval. It sucks not knowing before hand but...... If you have issues due to weight and have done what they ask, then it shouldn't be a problem.

If you are on straight medicaid there are different requirements, but if you are assigned to one of the managed care providers then it is really easy to get approved!! I have Optima through medicaid and all my doctors office did was send over a letter and I was approved the same day. As far as other surgeries I think medicaid looks at Lap-band as still experimental. 

My daughter has straight medicaid to and it is also through optima, she did not have to do a six month supervised diet.  Medicaid is different from medicare. i hope all of our answers are helpful for you.