Started paperwork today with UW and DSHS

Hi all. I'm finally getting the ball rolling for weight loss surgery. In the past few years, I've been told enough misinformation about the process and my "insurer" that I had given up for a while (an insurance specialist in my primary care physician's office flat out told me that it's not possible to get medicaid/dshs to cover surgery). In speaking to a nurse at virginia mason, I found out that DSHS does cover, but it requires a bit of paperwork and only 3 choices--UW, Spokane, and Portland. All the information from people getting surgery with DSHS in 2004 and prior seems to be invalid as the system has changed. What I would like to know is if anyone has had DSHS/medicare cover a 2005 surgery, where they went, and maybe some details on the process, because I'm entirely lost. Also, what needs to be submitted to DSHS by my PCP? Myself, I'm 26, have a BMI of 79.7 and no other important medical problems. My PCP and I filled out paperwork today to get on the waiting list for an initial consultation at UW.

approval is easy if you have medicare parts a and b, if so theres also wish center,, Im having mine done at virginia mason, what it depends on is your co morbidities, and how many of them you have, dshs medicaid will pay for the surgery if you can get your docs to submit paperwork basically the idea is to get medicaid providers to believe they will save more money by paying for surgery rather than have you going to the doctors all the time for treating your wieght related problems, I am seeing an endocrinologist, cardiologist, pcp, eye doctor, pullmonary doctor, gastrologist (dont think I spelled that right) I have usually about 8 doctors appointments a month. However I have medicare and medicaid and medicare approved my surgery within two days of submitting the neccessary paperwork. It is harder if you only have medicaid, but if you do have medicare look into DR. Hunter at Virginia Mason in federal way. Anyways goodluck to you. And keep us all posted as to how it turns out. Oh by the way Im scheduled for surgery next friday unless my labs show I need further treatement to reduce stomach acid in which case I would need to wait an additional to weeks to treat it.

Thanks for the reply, Tom. I don't have medicare A or B, but simply DSHS medicaid, apparently. Should I start by going to a bunch of specialists and then applying with medicare or am I right in trying to set up an initial appointment with UW? Should I not even bother getting on the UW waiting list until I get approval from DSHS? I'm a little frustrated because my PCP and my former PCP and myself are entirely new to this and I've been told conflicting things, thus I thought I'd jump the gun and get hooked up with the surgeons in the hope that their nurses can instruct me on paperwork and what specialists I should be seeing.

Oh and good luck to you on your surgery next friday!

If I were you Id go ahead and get on that waiting list cant hurt and if need be you can always ask to be taken off. As far as how to proceed. I dont know if you wieght affects you psychologlically like. But if it does seek counseling for it, thats just another cost and another reason to state that the surgery would be beneficial to you. I know because of my wieght I tend to avoid most social outings and family functions. If it affects you in that way or similiar, you should look into counseling and it will be helpful and will count as more reasons to get you approved for the surgery you want. Also tell your doctor about any minor problems you may have they add up. Like for instance if your knees ache, or you get pains in your ankles or back, Im not suggesting you lie but usually sooner or later bieng very overwieght catches up to us all and causes many problems, I think its a shame that you have to get deathly ill in many cases before theyll approve you, why not approve people that are significantly overwieght before making them suffer through other problems. Another thing you should do is ask your doctor to put you on a 6month diet plan, and it will probably fail, but I know its one of the things they ask for, that is seeing youve failed on a diet plan that was supervised by a doctor, this can be as simple as your doctor telling you to eat 1500calories a day and note your wieght each time you visit him over a 6month period. And they will want to know if youve tried any wieght loss drugs such as meridia etc. , and if you havent they will want a letter from your doctor explaining why you havent tried them, for me it was due to my high blood pressure. Hope this helps hang in there and remember anytime you experience discomfort or systems complain away to your doc lol. Almost forgot another big factor in helping you get approved is if you have sleep apnea , I dont know if youve ever considered getting checked or not, but I was told at VM if you have sleep apnea and a high bmi then your case for surgery is already very strong. Good Luck to you be sure to update us every so often.

Congrats on getting the ball rolling. Be prepared for a bumpy ride. Insurance approval is a b*tch. Be persistant and don't let them push you to the back burner. Good luck to you! Lori