Question-MediCAID

Britt_Bearpaw · October 29, 2011

Hi! I live in Ohio and was wondering if anybody knew if the Medicaid would cover the sleeve surgery? I am 25 with a bmi of 65 and I weigh 430 pounds. However, nothing else is wrong. I have no sleep apnea, blood pressure, diabetes or anything. I think that is why my primary doctor hasnt suggested the surgery and doesnt seem interested in helping me get the surgery. I was thinking about going to Mexico but I am a full time student so money is tight...I know for sure this surgery is right for me. I see people less than HALF my size getting insurance approval and it makes me so sad because it feels so out of reach for me cuz I only have Ohio Medicaid...

lostalongtheway · October 29, 2011

Call your local office and ask them what all do they cover.

Britt_Bearpaw · October 29, 2011

I called and the lady was very vague and kept telling me that my doctor has to start the process, which he wont. and she basically didnt know anything else. she has no idea what WLS they cover or dont. yea, calling wasnt a help at all.

Felicia · October 30, 2011

I have Illinois Medicaid, I have no idea if they are the same but here is what I had to do. So in order for you to get the surgery almost everything has to be on a "referral" basis. I called medicaid many times, they helped me little to absolutely none with anything.

I went to my WLS seminar first to find out if they would take my Illinois medicaid, I got the packet and had to have my primary care doc refer me. Once my doc referred me the weight loss place took over. They referred me to numerous places. I have had blood work, sleep study, stress test, EKG, chest xray, there are more but I can't remember them all right now.

Anyway, I felt I had no bad co-morbities either. I have depression, slight arthritis, and a long diet history but nothing huge, or so I thought. After getting my sleep study I found out I had CSA. Central sleep apnea, and also some scans said my arthritis is far worse than I thought.

Point is you may have issues you don't know about. If I were you I would either change your doctor or start asking for testing to be done. The truth is you are in the range for surgery, you don't even need to have co-morbids to qualify, so if your doctor isn't going to help you then find a different doctor who will.

I have had to change my doctor many times because sadly when you have medicaid most docs don't treat you well, or that is my experience. If you have a weight loss surgeon in mind you may want to try and call their office for help. They may be able to recommend a doc who takes medicaid who would be willing to refer you. Good Luck! Keep pushing forward and you will eventually get the sleeve, it's just gunna take time.

Britt_Bearpaw · October 30, 2011

Thank you Felicia! I know what you mean about being treated like crap if you have medicaid. The lady on the phone from my insurance was rude and wouldn't give me any information regarding how I can start the process to get WLS. I dont want anything but the sleeve, but she wouldn't tell me if it was covered or not either. I have done the sleep test, no apnea. I have done the ekg with another doctor, so I wonder if I can use those past attempts towards this application. It wasn't more than 2 years ago...I hate what you have to go through to try to get healthy. Clearly Im a canidate-why do I have to jump through hoops just to get this? It's almost like they want you to suffer.