QUESTION

I really would like to have the gastric bypass surgery. I am on DSHS Medicaid. My blood lab work is all good except my HDL level was abnormal. Mine was 37. Normal is greater than 45. My BMI is much greater than 35%. I seen a orthopedic doctor the other day and he gave me a diagnosis of PF Chondromalacia. He said that weight makes it worse. Is this enough to try and get approval for the surgery??????

Can't hurt to try! The worst they can do is say no - the best is YES!! Best of luck to you. Michelle 340/202/???

Thank you Michelle.

Dear Debbie: It is my undestanding that DSHS does not cover bariatric sugery for any reason...but then I could be wrong. My motto is if you don't ask/try the answer is always going to be 100% NO. If you do ask/try....you have a 50-50 chance....much better odds.!!! Please let us know what you find out so that we can pass information along to others. Good luck to you and you will find friends and information here. Karen

Thank you Karen. Here is what I know about Medicaid when I had e-mailed them about bariatric surgery. DSHS will cover gastric bypass surgery if the client meets the strict criteria. There are three stages of criteria to be met and the doctor will have to submit for authorization for each stage and get approval for each stage. STAGE ONE is the preliminary approval stage. You must be between 21 and 60 years of age, significantly overweight with a BMI of greater than 35, and you must have specific medical issues associated with your weight. STAGE TWO is the pre surgical approval stage. You must not be abusing drugs or alcohol, you must undergo extensive psychosocial testing and mental health evaluation, and for at least 6 months you must receive nutritional counseling and lose 5% of your total weight through diet and exercise programs (surgery candidates also receive therapy). STAGE THREE is the surgical approval stage. For this stage reports and documents are reviewed and surgery is scheduled if the criteria in stages one and two have been met. I am just worried that I will be turned down. I am also worried because I have severe depression that it will be of concern. I am trying very hard to take a day at a time. I will be seeing a new PCP because my doctor is moving out of state. I live in a small town and I am hoping my new doctor will be okay with my decision of WLS and that she can write up the information right to DSHS. I am not sure if I need to write anything to DSHS for her to include. And if I should and can write my letter to them, how it should be done.

Hi Debbie, If you don't try, you will never know. I say, get the ball rolling. Hopefully your new doc will be supportive of WLS. If so, that is your first step in the right direction. By all means, WRITE A LETTER! Explain all the diet attempts you have made in the past, how your weight has fluctuated over the years, any problems you are having because of your weight, health issues, etc. Put as much info as you can. It really can't hurt to give them a more clear picture of what you go through daily because of weight problems. Make it heartfelt. Make sure your doctor knows that you want to send this letter with his/her recommendation for surgery. Take care and let us know how things progress for you. Take care, Lori

Thank you Lori for your encouragement! You are so pretty. I hope to be one day too. I see my new doctor on July 26th. I just received today a letter from the orthopaetic doctor about the diagnosis on my knees. I am taking it to my new doctor. It is bilateral patellofemoral chondromalacia. He said the combination of my knee anatomy with my obesity is contributing to my knee symptoms. He said weight loss would be beneficial for my knees. I hope medicaid will except this. I have good results on all my blood work. No diabetes even though it runs on both my sides of my family. My BMI is 53%. Super obese! I am just worried that my health issues won't be enough. I will write a letter. Great encouragement from your reply. Is it to much to ask if you would mine sending me a copy of what you wrote? I would like to get a idea of how you worded things and explained your health issues. I appreciate your help! Thank you Lori, Debbie