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does medicaid pay for lap band (not medicare but medicaid)

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Started by sassie21898, May 08, 2008 10:39 AM
80 replies to this topic
80 replies to this topic

    sassie21898

    Newbie

  • Posts: 8
  • Joined: May 2008
  • Surgery: LAP-BAND
Posted May 8, 2008 - 10:39 AM

#1
i am getting a lit confused. i keep hearing about medicare paying for surgery. i am 24 5'5 and wiegh 245lbs. i have back problems and knee problems. my bmi is 42 so under a group insurance i would quilify but i dont have a job that offers any insurance. i am a low income person and would love to her from someone that has had this type of situation!!


    jtcr3

    Newbie

  • Posts: 7
  • Joined: May 2008
  • Location: NEBRASKA
  • Surgery: LAP-BAND
Posted May 8, 2008 - 10:59 AM

#2
Medicaid just paid for mine. I know it is getting harder for them to get it approved. With medicaid you have to have at least 2 pre-existing conditions caused by obesity and I can't remember the bmi I think over 35. My doctors got it approved for me. You also have to have a psych evalutation and if there is any depression medicaid will make you do counseling for a while before they will pay for it. Have you been checked for sleep apnea yet? That is a big one that will help get it approved.


    kathystrick

    Sweet freedom!

  • Posts: 1,072
  • Joined: Oct 2007
  • Gender: Female
  • Location: SC
  • Surgery: LAP-BAND
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Posted May 8, 2008 - 11:13 AM

#3
I was reading about this on another site earler and there also seems to be a problem with getting doctors to take Medicaid patients for surgery. The article I was reading said that Medicaid reimburses at a much lower rate than private insurance or self-pay, so many have become hesitant about taking it.


    ashleynicole

    Newbie

  • Posts: 6
  • Joined: Apr 2008
  • Location: GEORGIA
  • Surgery: LAP-BAND
Posted May 8, 2008 - 11:55 AM

#4
Hi! I know i am confused too. I do know that medicaid will pay for surgery. I am on Peachstate/ medicaid..and i have been asking people if they got approved through them. I am 25 and also 245. I am going to a seminar on may 17th just so i can get info. I need to know exactly what test i need and etc. Ill will keep you informed on anything i find out :biggrin:!! What state are you in?


    jrg1979

    Expert Member

  • Posts: 114
  • Joined: Jan 2008
  • Location: TEXAS
  • Surgery: LAP-BAND
Posted May 8, 2008 - 12:00 PM

#5
I heard somewhere that Medicaid will pay for lap-band, but you cannot find a surgeon that accepts medicaid.


    massa36

    Advanced Member

  • Posts: 48
  • Joined: Mar 2008
  • Location: GA.
  • Surgery: LAP-BAND
Posted May 8, 2008 - 12:08 PM

#6
Hey I have medicaid in Ga, and they do cover the surgery. I am awaiting my approval right now, and have no doubt I will be approved! I have to have the following test to submit for approval : physical exam for medical clearance, cardiac clearance, blood work, psych eval, nutrition eval. Once those are completed, my dr. turned the info into the insurance. So now I wait! Please keep me in your prayers and I will defintely let you all know what happens!


    blaze21

    Bariatric Evangelist

  • Posts: 863
  • Joined: Feb 2008
  • Gender: Female
  • Location: NC
  • Surgery: LAP-BAND
  • Surgeon: Prashanth Ramachandra
  • Surgery Date: Jul 2008
  • Starting Weight: 257
  • Weight Lost: 129
  • Current Weight: 128
  • Goal Weight: 130
  • BMI: 21.3
Posted May 8, 2008 - 12:40 PM

#7
Call your provider's customer service to see if they cover the procedure, and they can direct you to a doctor from there. Although Medicaid is a federal program, it should be the same from state to state, the plan you have under Medicaid may or may not cover it.


    sassie21898

    Newbie

  • Posts: 8
  • Joined: May 2008
  • Surgery: LAP-BAND
Posted May 9, 2008 - 8:27 AM

#8
i am in augusta georgia. i am waiting for my medicaid application to be done i just applied for medicaid. how long does the evaluations take? does any state take your medicaid or does it have to be in georgia? does any one know a doc that will accept it in georgia? where do i start after i get my medicaid card? sorry so many questions, but i really need to know!! thanx for all of your replies


    sassie21898

    Newbie

  • Posts: 8
  • Joined: May 2008
  • Surgery: LAP-BAND
Posted May 9, 2008 - 8:30 AM

#9
congratulations on you lap band being approved. what did you have to do to get it? how long did it take? how much out of pocket did you pay? where are you i'm in georgia? i hope i am as luck as you and get approved too!!!


    Gunfighter9

    Honor & Courage 1-8 Cav

  • Posts: 5
  • Joined: Sep 2008
  • Location: NE
  • Surgery: LAP-BAND
  • Surgery Date: Nov 2008
  • Starting Weight: 301 lbs
  • Weight Lost: 105 lbs
  • Current Weight: 196 lbs
  • Goal Weight: 180 lbs
  • BMI: 29.8
Posted September 4, 2008 - 9:11 PM

#10
I don't know if anyone can help me with this or not. I am in the process of getting approval for the lap band. I have done the pulmonary exam, the dietician, and I have an appointment with the pyschologist on Monday. I was told by the Nurse at the Dr.'s office that Shared advantage which is one of the medicaid programs in NE is not really keen on approving this procedure. Does anyone have any experience with shared advantage? Any info would be helpful. Thanks.

Edited by Gunfighter9, September 4, 2008 - 9:18 PM.



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