UW questions?

·                     .RE: Referral to the University of Washington Bariatric Clinic Washington State DSHS (Medicaid) Guidelines for Bariatric Surgery

Dear Interested Candidate:

·                     If you have Washington State Medicaid (DSHS) as your primary health coverage, the following letter contains useful information necessary to proceed with Bariatric surgery at the University of Washington Medical Center. Please note that these requirements were created by the Department of Social & Health Services and NOT the UWMC. Washington State DSHS guidelines must be followed to ensure that your bariatric care is covered financially at the UWMC.

·                     Please read through the individual steps/requirements/criteria below.

·                     Stage 1 (Preliminary Approval)

·                     You MUST meet the following requirements. If you do not, then you do not qualify for bariatric surgery under DSHS regulations and Washington State Medicaid under no cir****tances will pay for this type of treatment.

·                     Criteria: Age -You must be between the ages of 21 and 60.

·                     Body Mass Index (BMI) - You MUST have a BMI equal to or greater than 35. (This number is determined by your primary care provider or by using standardized BMI calculators that can be found on the Internet.)

 Medical conditions/Co-morbidities – You must have ONE of the following conditions:
o Diabetes Mellitus Type II requiring medication and/or;
o Degenerative Joint Disease of a major weight-bearing joint(s), such as knees or hips, requiring joint replacement (excludes arthritis in back or Degenerative Disc Disease You must NOT have multiple sclerosis (MS), whi*****reases risk of mortality. Please note: the only exception to these medical conditions is a rare brain disorder called pseudo tumor cerebri that must be documented by a physician.

·                     While there are a number of other medical conditions that are often a result of obesity, they do not qualify for gaining DSHS (Medicaid) approval. In the case that your condition does not satisfy the requirements for approval, we recommend you continue to explore other options with your primary care provider to find a non-surgical weight loss solution.

·                     Those who do qualify with the above criteria should contact their Primary Care Provider to complete Stage 2 of the DSHS process.

·                     Stage 2 (Pre-Surgery Stage)

You and your Primary Care Provider (PCP) must complete the DSHS application to Stage 2 approval and fax your medical records to the DSHS committee for review. The Washington State DSHS phone number is 360-725-1584. The DSHS fax number is 360-586-1471. DSHS will provide a ruling on your request. You will receive an official letter from DSHS with the approval or denial of your request.

When/if you receive a letter of approval, you need to begin work with your PCP on the next step of Stage 2: the Diet and Exercise requirement.

·                      Diet & Exercise – You must participate in a 6-month medically supervised weight reduction program, and must lose 5% of your weight in that time. (Example: If you weigh 300 pounds, you would need to lose at least 15 pounds during the six months). In addition, you must maintain the weight loss until surgery.

·                     During these 6 months you must also:

·                      See a supervising physician, (usually your PCP) once per month for 6 months;

·                     See a registered dietitian twice monthly for 6 months (Your PCP can help you find someone);

·                     Maintain a journal of consistent diet and exercises completed in this time.

·                     After the completion of your 2nd month supervised weight loss, your PCP will contact UW Medicine’s Bariatric Program (Intake phone #: 206-598-2274) to enter UW Bariatric program.

·                     When we receive records, the DSHS letter of approval for stage 2, and letter of referral from your PCP including documented weight loss up to this point, we will contact you to set up appointments for the final steps leading to surgery:

·                     Bariatric Seminar – You will be scheduled to come for a required Bariatric educational seminar.

·                     Surgical Evaluation – After the seminar visit, you will be scheduled for a consult to see the surgeon who will examine you and evaluate you for the actual surgical procedure.

·                     Psychosocial Evaluation – to be completed at the University of Washington Medical Center with a licensed psychiatrist or social worker.

·                     Important! You must continue your visits with a dietitian and PCP to complete the remaining steps of the DSHS requirement while you are enrolled in our program.

·                     Stage 3 (Authorization for Surgery)

·                     Following the process above, the Bariatric Team at UW Medicine’s Center for Bariatric Surgery will complete the necessary steps for approval and scheduling for surgery. This process includes submission of all of the Stage 2 records, including the surgeon’s recommendation, to DSHS for final review. DSHS will do a final evaluation of your records and make a final determination of approval for surgery.

·                     Once DSHS has made its determination, you will receive an official letter from DSHS to inform you of your approval or denial to Stage 3. If approved, you will need to immediately fax the UW Bariatric Team a copy of this approval letter to 206-598-6705 or 206-598-9470. Once we receive a copy of this letter, we can schedule your surgery.

We hope that this letter and these guidelines listed explain the process for you and assist you in obtaining approval for bariatric surgery with DSHS insurance at UW Medicine’s Center for Bariatric Surgery. Please check out our website at www.uwbariatric.org for further information. We wish you the best in your efforts.

Sincerely,

The Bariatric Team
UW Medicine Center for Bariatric Surgery