Stage 1-DSHS approval??

Today was my surgical assessment appointment with my PCP. It went well, my doc says I definitely meet all the requirements for Stage 1 in the 3 stage process for getting approval from DSHS. He faxed my H&P, the labs they requested and the form they faxed him after filling it out. Now I just wait to see what happens I guess.....does anyone know how long this usually takes? They say they will send a letter to me and my doctor letting me know if I can move on to stage 2....and I am hoping and praying I get to! Dawn

Hi Dawn,  I started all of this back in April of this year. It feels like forever to wait for things to come through but it seems to all fall together. I now have a surgery date of 7/30/07. I know the wait is different for everyone. I used this time of waiting to do all the the research and information gathering that I could. I started a journal and started collecting little sayings and pictures that I will use for inspiration in the coming months. I also read different recipes for bariatric people. I think by doing all these things the time went by easier then if I would have watched the calendar Hang in there!

Hi Dawn, That is so exciting to hear.  Congrats on making the first third of your journey, you are almost there.  Keep us updating on your progress.  Can't wait for you to join me on the loser's bench.  Hopefully your surgery won't be too far off.  Keep your chin up and remember you have made it this far, you will suceed in making it all the weigh to the loser's bench.

Fantastic news!  I will be watching your story closely...  as I am going to head down the same road soon.  First I have to apply for medicaid...  Will be doing that very soon.  I am quite sure I will qualify for the Medically Needy program.  I am just not sure what comes first the surgeon or the coverage..LOL

Hi! Good luck applying for Medicaid! I do know you have to go through a primary care doc first. There are 3 stages to Bariatric Surgery approval through medicaid....first stage is handled completely by your PCP....he/she fills out the standard medicaid form that they will not give to you, the patient, your doc has to ask for it and they will only fax it to them.....they also will not send the packet detailing the process to you, only your doc. My doc did give me a copy though and I read it all....it states pretty much everything their website says if you read the WACs regarding bariatrics.  So I am just waiting to see if I met their requirements for stage 1. BMI, age requirement, and the co morbidity, they requested certain labs....LFTs, Thyroid, and a CBC I think it was....and One Hour Glucose test as well....all of which my doc had just done on me. Plus a detailed H & P from him....if they approve all of that, then you can contact the surgeon and make an appt to see him/her. Good luck to us!!! Dawn

Cool - I am going to the information seminar on Aug 1 at Rockwood.  Then I will apply for the medicaid medically necessary coverage. I have to go to my doc to get BP meds renewed this month.  I am going to ask him about WLS then.  If I get the nod there then I am on my way....  medicaid is the only thing that can screw this for me... but I cant imagine that we dont qualify...  I am SOOOO broke...LOL

I was looking again at the wacs for this and I have a question....  do "regular" co-morbidities like high blood pressure, arthritis, etc not count???  see below... Stage one -- Initial assessment      (5) Any department-enrolled provider who is licensed to practice medicine in the state of Washington may examine a client requesting bariatric surgery to ascertain if the client meets the criteria listed in subsection (6) of this section.      (6) The client meets the preliminary conditions of stage one when:      (a) The client is between twenty-one and fifty-nine years of age; I'm 39 good to go there      (b) The client has a body mass index (BMI) of thirty-five or greater;  yup - got that one beat      (c) The client is not pregnant. (Pregnancy within the first two years following bariatric surgery is not recommended. When applicable, a family planning consultation is highly recommended prior to bariatric surgery);  nope... no babies on board      (d) The client is diagnosed with one of the following: uh oh.....      (i) Diabetes mellitus;  nope not yet      (ii) Degenerative joint disease of a major weight bearing joint(s) (the client must be a candidate for joint replacement surgery if weight loss is achieved); or  I have joint issues for sure... but I dont know if I need joint replacement...       (iii) Other rare comorbid conditions (such as pseudo tumor cerebri) in which there is medical evidence that bariatric surgery is medically necessary and that the benefits of bariatric surgery outweigh the risk of surgical mortality; and I dont even know what this is.....      (e) The client has an absence of other medical conditions such as multiple sclerosis (MS) that would increase the client's risk of surgical mortality or morbidity from bariatric surgery.  nope no ms so I am ok on this one      (7) If a client meets the criteria in subsection (6) of this section, the provider must request prior authorization from the department before referring the client to stage two of the bariatric surgery authorization process. The provider must attach a medical report to the request for prior authorization with supporting documentation that the client meets the stage one criteria in subsections (5) and (6) of this section.      (8) The department evaluates requests for covered services that are subject to limitations or other restrictions and approves such services beyond those limitations or restrictions when medically necessary, under the provisions of WAC 388-501-0165 and 388-501-0169. so if I read this correctly, until I need joint replacement, or I have developed diabetes I dont qualify...  Is that right? 

That is my understanding as well! Yep, like you, I am worried about that one issue....have everything else covered. I do take Metformin twice a day and am ordered to check my blood sugars twice a day and I did fail the one hour glucose tolerance test, which is a test they require your doc to do on you before you finish section one. So, I am hoping....eventhough my doc calls me glucose intolerant vs diabetic, they will accept that. And I barely failed the fasting sugar blood draw as well, the high cut off was 99 and I came it at 101. I don't call that bad, but maybe it will work in my favor in this case. 

I'm thinking I've never watned a diagnosis of diabetes so bad...LOL wonder what happens if you drink a large regular coke before the test!  LOL

Since you are supposed to be fasting, I think it can't do good things LOL They do make you drink that sickingly sweet drink, mine was orange and then you have to sit there for an hour....they wouldn't even let me leave...which is different than last time....I wonder if that is because people have been not been following the instructions?