New/DSHS Questions...

I have only recently decided that WLS is right for me, though I have been overweight since my teens. I turned 40 on May 1st and I think that was HUGE in pushing me to make a decision! No more putting off till tomorrow, ya know? Anyway, I have DSHS and Molina....from all my reading on the subject I understand Molina does not cover bariatric surgery but my coupon from DSHS does! So, after about 3 hours i found the WACs online (they don't make it easy!) and was happy to see that I more than met their requirements for BMI, body weight....and am starting to develop my first comorbidities, which I guess is good since They require at least one! I have been on every diet in the world....nothing has given me any lasting success.....and with each *failure* i grew larger!  Today I called DSHS, the number on the back of my coupon....and the lady was nice, and told me it is a covered procedure but it would be a year or two, the process, until surgery! I was LIke WTH???? on the government website it states there are 3 steps...PCP submits letter to DSHS requesting the procedure...they approve or deny....then starts a 6 month nutrition and pcp followed *diet* where you must lose at least 5% of your body weight and keep it off until day of surgery (if any is gained back, they will cancel you and make you start all over!)....ok, I can deal with that....but this lady today said it's a year or two on the nutrition thing? That is definitely not what the website said....then I got to wondering...since we can only go to U of W for the procedure, is it because of the back log of patients waiting? and not the actual requirements of the state insurance?  And how the heck do you get on this waiting list? I have tried calling several times and left all my info as their voice mail requests at the new patient intake line for bariatric surgery....even sent off an email the other day, all to no avail, so far. Anyway....I am going to be asking my doc for the letter to be sent to DSHS soon, does anyone have any tips as to anything I should mention specifically in this letter? I don't know how experienced these guys are...its a new clinic....but part of Franciscan Health System, who does the surgery themselves...but this is a family practice doc! I would appreciate any words of wisdom! Dawn

make sure everything is documented as you go- the people who have the hardest time with the state are those who arent meticulous about documentation- i would always get copies of all my visits for everything- then if something wasnt in the paper work that was suposed to be i would go back to the office and have the doc or nurse fix it-

Hi Dawn I also have Medicaid, but now also have Medicare. Medicaid doesn't make it easy to find out anything. I think they really don't know. Medicaid does have 3 steps. The first is to have a doctor that will agree that you need the surgery.  When the doctor sends the letter in make sure that you have all your past diet attempts listed,  because they require it. Once they approve you. Your next step is a diet and exercise program for 6 months. You can use your own doctor.  You don't have to join a gym, just talk to your doctor and tell him what your doing for exercise. Like walking, swimming, using your own weights, ect... Make sure your exercise program is discussed when you go in to see your doctor on your monthly visit so it is documented. You will also need to see a nutrition only once a month. When you complete your 6 months, and lose at least 5% of your body weight, whice you already know. Your ready for the last step, surgery.... I am on the waiting list at the UW. I have been on the list for 1 1/2 years. It is a long wait, but is well worth it. On the UW's website they have the forms that they  want you to fill out before they put you on the waiting list, plus they will need a copy of your medicaid coupon.  If you can print them out you can get the ball rolling for yourself. One form is for your doctor to fill out. The sugeron wants to make sure that your doctor is willing to do all of your follow up care. Because they don't do long term follow up care. If your unable to print them out, have them send you the forms. Just hang in there they will call you back. It took them a few days to call me back also..... I hope this has helped some, and I didn't confuse you. If I can be of any help let me know.  Barb

Thank you Barb! That is very helpful...I have called a few times in a two week time period and I have never had a return phone call! I am going to look again, but if you have a minute, could you please point me in the direction of the forms! I have another appt with my pcp in a month and I would like to get them all ready for him! I didn't notice the forms in any of my last trips to the UW website, but I could have overlooked them! I asked at my pcp and they have a lot of patients that have gone through some kind of WLS, so I am sure taking care of me afterwards won't be a problem for them! Was it after your 6 month nutrition or diet period that they put you on the wait list? or do they put you on it right away and give you all that time to jump through the rest of the hoops? Also, do they keep in any kind of contact with you while you are on the waiting list? Any idea as to when the end is in sight for you?? Thank you again, so much!

Hi Dawn I went online to the UW website for bariatric surgery. They have changed their website. I cannot find the forms either. They must of taken them off. You can get on the waiting list at the UW as soon as you send back the forms and a copy of your medicaid coupon. The UW wants to make sure a person has insurance before they will put you on their list. Just keep calling and bugging them. They will call you back. You don't have to wait to complete your 6 months diet, exercise, and nutrition programs. I was wrong about the dietcian, they want you to go  twice a month. Your doctor is once a month. But don't forget to discuss your exercise program with him at every visit, so it is documented.  No, the UW doesn't  keep any kind of contact with a person while you are on their waiting list. I have called to check on the status, and to make sure they know that I am still alive. LOL I just received medicare. When my doctor sent in the request for surgery I was on medicaid alone. At the time I only had the one co-morbid condition, degenerative joint disease. But now I have type 2 diabetes. It is a long wait. But it is worth it. I am 53, I have 3 grandkids. I want to get my health back so I can take them places, like the zoo, swimming, ect....Because I have medicare now, my doctor will send the request into them. I hear they  are so much eaiser to get approved. They don't require what medicaid requires...I hope this helps. I know how frustrating it can be. Medicaid doesn't make it easy to find out what a person needs to do. I have gotten most of my information from this website. The people on here are great. It's people trying to help each other and I think that is woderful. I hope I have been of some help to you Dawn. Feel free to ask me anything. I wil try to help as much as I can. Just don't give up.  Barb

Believe it or not it can be done.  I had surgery last Aug at OHSU in Portland, OR.  They are a center of excellence for us dshs'rs.  They have no waiting list and are wonderful to deal with.  I was the first wa dshs client they had.  I was also on Molina and a CNP coupon.  Get the comorbidities thouroughly documented and then have your physician request step one.  If you are approved for step two they will send you paperwork that explains the next step.  Instead of sitting back and waiting for things you need to be sure to call and bug them constantly!!!  Persistance and determination are essential when working with them.  You have to make things happen!!!

I can go to Oregon????? I didn't know that was possible! I am wondering if I don't meet the co morbidities requirement though. They list Diabetes, high blood pressure and one of the more serious one like Intra cranial hypertension. Is that all they will accept? Oh, they also have DJD. I have not been diagnosed with anything! I am "pre-diabetic", I have PCOS, I was put on Metformin this month for random elevated blood sugars, my one hour glucose tolerance test was borderline high....but he still says I don't have full blown diabetes, but definitely will in the very near future if I don't lose weight!!!  I am not just sitting here waiting for somebody to come to me...I have made repeated phone calls to the U of W and never get a live person, have left many messages with all my contact info and nobody ever returns my call. From all of my research, and from talking to the Medicaid people, who thankfully, answer the phone and were really very helpful, and from talking to other WA patients, it would be several years...not because they wouldn't approve me, but because U of W only takes so many medicaid patients a month and they have way more asking for the service then they are allotted to care for yearly.  I can't believe that more WA patients haven't just gone to OR if it was really that easy!!  I certainly don't mind travelling there.  I really appreciate you sharing your story! I will be looking into this for sure!

Is it possible to qualify for DSHS if you are self employed and have private pay insurance that excludes WLS?  we dont make much money but I certinally have the co-morbidities necessary to qualify!

Hi! I don't know if they do, it would depend on your situation, but I am pretty sure you can only qualify for Medicaid if you have children under 18 who qualify, or if you are meeting the income guidelines, or if you are disabled. You can search the website...they do list the requirements and you can apply online if you think you meet them. Sorry I am not more help!DSHS - Community Services Division HOME PAGE  I don't know if this link will work....but this has all the info!

well I've decided it cant hurt to try!  I have ordered the packet from Rockwood clinic.  I will go to one of their meetings and see what to do from there. 

I am hopeful that I can find out which comes first  - the doctor or the coverage!  Do I apply for medicaid first and then go see the doctor?  or do I get the doc to say I need the surgery and then apply for the coverage?  LOL  round and round I go... Of course if I have to apply first I will not qualify because I do have coverage already - but If the doc says I need the surgery, which I belive I do (BMI of 50, high blood pressure, knee problems) then I am sure we can qualify finanically as a family of 3 who had an adjusted gross income of just over 20K last year. thanks for your response.  I am excited to get the packet in the mail.