DSHS covering WLS? DO TELL!

Hi Everyone! Okay, some people have written me and told me that DSHS covers WLS...Have any of you heard about that? If so, who are the doctors performing it and what surgeries does DSHS cover? How long does it take to get qualified/approved, and what is the approval process? PLEASE let me know ASAP. Thanks! ~Darcy Yakima

Hello darcy, if you have medicaide you can get wls IF it is medicully neccesary. -bmi 35% With comorbities or 40% and above without comorbities. Last year was alot harder. U of W seattle takes medicaide there is a long wait list about 1-2 years. But it is good to get on the list. If you can travel to Spokane Spokane Surgery Specailitys do as well 509-747-6194. Oregon Health Sciences also MAY take in another month. This [place is in Portland) After your appt with a surgeon you have to go on a diet by a doc and prove you can lose 5% of weight. Six month long. Get psyck evauls............. not sure what types of surgeries they do approve. The medicaide office will not help in any way it is best to get info is directly from surgeons that take it. More facillitys in Seattyle area may be approving medicaide as of Jan 1 it became easier to get wls on medicaide. good Luck Please Let me Know if you got in Paula

as far as I know they only cover rny. I had a long converation with rep. from dshs, I called the number on the back of the coupon. You just have to ask alot of questions, he was very helpful. The first step is to ask talk to your dr. about it, the dr. then has to put in a request for prior authorization, your dr. must submit enough information/records to prove that this surgery is a medical necessity. I had them fax me the requirements for med. necessity and it said diabetes, joints which would be suitable for replacement after the surgery is performed, or other rare medical conditions and it listed one which I cannot remember but it had to do with blindness. If medicaid approves that then you move on to the 6 month physician supervised diet, during this time you meet with a nutritionist a few times and a psychologist at least once, You must loose at least 5% of your total body weight during this 6 month period to be elligible for your final approval. I personally do not have diabetes, joints that need replacing (not yet anyway), or any condition which I consider to be rare, but I do have several co-morbidities and my dr. and I both know that this is a medical necessity. We will see what happens. If they deny me this year I will appeal. Last year I was denied and didnt appeal, hopefully its easier this time around. I have heard from many sources that it is much easier to get approval this year, my fingers are crossed.

Hi! My name is Debbie and I live in Chelan, WA. My PC doctor told me that I may want to look into DSHS/ medicaid for coverage for the gastric bypass surgery. I got a hold of DSHS and was told it is covered...yeah! I was told there is 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. So now I am worried that I may not have the weight issues they are looking for. But I do have a BMI of 52% and I found out that puts me at a 106% increase risk of dying as compared to a person with a BMT = 21%. I already had my gall bladder removed and I do have acid reflux. My weight has made it hard for me to do much. My back starts to hurt even to walk! Would you or anyone else reading this know if this would be enough for that criteria to be met? I hope that you're right Holly...I really hope they have made it easier for us to get the surgery. Please...all of you...we need to support each other with any information we find out that may apply to anyone. I pray that DSHS can see all of our health needs to get these surgeries approved for us!