medicaid insurance guidelines for surgery
Does medicaid cover VSG surgery? I keep getting conflicting answers. Is the coverage according to what state you are in? I am in Wisconsin. My insurance is ForwardHealth Core Plan without an HMO. This is part of medicaid but for low income people with no children. I cannot get a straight answer when I call them. One person told me it was covered. I called back a week later to verify and was told they can only give that info straight to the doctor. This is really frustrating because I will only get the wls if it is the VSG .
I'm in California so I honestly have no clue. Have you checked the web site on line? Sometimes they information posted. Perhpas your Primary care physician can call and find out? Do you have a good relationship with him/her? Good luck.
I'm Just Robin!
Highest weight 250 - Goal Weight 150 - Current Weight 147
*** Hanging with Weight Watchers now to keep on track ***
Highest weight 250 - Goal Weight 150 - Current Weight 147
*** Hanging with Weight Watchers now to keep on track ***
Yes, Wisconsin Medicaid DOES cover VSG :)
However, they are VERY Hush-Hush about it, and won't even tell you what the requirements are. All they say is, "Once you submit all of your surgeon's paperwork in, we have a team look at it to see if you are a candidate". When you ask about the specific surgeries covered, they will only say, "We can't give out this information, it's against our policy".
I worked in medical billing for over 10 years. I spent the span of a few days on the phone...call after call after call, waiting for managers and supervisors to give me an answer to my questions!
I finally got the answers I needed. They are pretty much the same as other insurances - need to have a BMI of 40 or 35 w/2 co-morbidites....6 months of nutritionist appointments (once per month for a total of 6), all the normal pre-op stuff - like psych eval, labs, etc, and I can't remember how much of a history of weight loss attempts.
They cover the VSG. I was soooo happy!! The only way I got the answer was to have the CPT code - they don't know it by name at all.
WI Medicaid as a program either covers something or doesn't. It doens't matter if you are in an HMO or not, they are all supposed to be covering and not covering the same things.
The biggest issue is finding a provider/ surgeon that you like that is IN network AND takes WI Mediciad.
Good Luck.
However, they are VERY Hush-Hush about it, and won't even tell you what the requirements are. All they say is, "Once you submit all of your surgeon's paperwork in, we have a team look at it to see if you are a candidate". When you ask about the specific surgeries covered, they will only say, "We can't give out this information, it's against our policy".
I worked in medical billing for over 10 years. I spent the span of a few days on the phone...call after call after call, waiting for managers and supervisors to give me an answer to my questions!
I finally got the answers I needed. They are pretty much the same as other insurances - need to have a BMI of 40 or 35 w/2 co-morbidites....6 months of nutritionist appointments (once per month for a total of 6), all the normal pre-op stuff - like psych eval, labs, etc, and I can't remember how much of a history of weight loss attempts.
They cover the VSG. I was soooo happy!! The only way I got the answer was to have the CPT code - they don't know it by name at all.
WI Medicaid as a program either covers something or doesn't. It doens't matter if you are in an HMO or not, they are all supposed to be covering and not covering the same things.
The biggest issue is finding a provider/ surgeon that you like that is IN network AND takes WI Mediciad.
Good Luck.
History: Highest:259 Surgery Day:227 Current:151 Goal:145 Surgeon Goal: 160
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