Help please. WASHINGTON

[dreamingvsg 2]

I went to a seminar last night in kirkland, Washington at evergreen hospital. Now what? I need to find a surgeon there that accepts medicaid amerigroup does anyone know any that will?

[jenbaby75 283]

Start calling bariatric centers, they can tell you. I am having mine done at Puget Sound Surgical Center in Edmonds. They are amazing.

[dreamingvsg 2]

Did u have medicaid?

[jenbaby75 283]

No, but any center should be able to tell you if they accept your insurance.

[yogachick 56]

Dr anwar in federal way

[dreamingvsg 2]

@@yogachick accepts medicaid? At what hospital.

[alysia.rush 24]

Not sure if you already found the info you are looking for or not, but I also am in medicaid and amerigroup.

the only approved place is University of washington because it is a center of excellence.

call the u.w weight loss management center. I have my consultation on tue.

[dreamingvsg 2]

@@alysia.rush

Are you serious? I've been trying to get my doctor to work with me in getting me the gastric sleeve at UW. And they keep emailing me either saying amerigroup won't cover it or it's not medically necessary. I have the right bmi to have surgery and have pcos. So in my mind I think they didn't actually call. I really want to switch doctors so bad. I've been trying to get the sleeve and been getting knocked down each time. I wish I could send you the screen shots from my doctors office. My only hope is probably save and go to Mexico....

[alysia.rush 24]

What town do you live in? My doctor was willing to put in the request for me. Sounds like yours just is not. I would talk to another doctor. Because it is covered, it just needs to have a pior authorization.

read page 65 it states:

https://providers.amerigroup.com/ProviderDocuments/WAWA_Provider_Manual.pdf

Surgical Procedures for Weight Loss

Consistent with strict guidelines of WAC 182-531-1600, surgical procedures are covered for weight loss as determined medically necessary. Amerigroup reviews each case for medical necessity. The Washington administrative Code (WAC) specifies detailed criteria required for coverage

I live in port townsend< the only part so far that is not covered is the Nutritionist. You will be an a medical required diet for 6 mo. and will need to see one every 2 weeks for 6 months. My hospital is letting me see theirs and they are paying for it under a charity fund. So see if you can find something like that or sliding scale, ask and call around.

I would start by call other doctors and ask if they can reefer you to bariatric surgery.

Do not give up. Im not, not this time, I gave up years ago, not now.

If you have any questions I will try to help. I go to U.W tomorrow for my first appt. there , excited and nervous.

[dreamingvsg 2]

I live in Tacoma. Honestly I think my doctor doesn't support stuff like that, maybe that's why she's acting like that. I've been trying and trying. I'm 24 years old and I just want to live my life finally, it sucks.. Good luck tomorrow I hope it goes smoothly.

[alysia.rush 24]

I live in Tacoma. Honestly I think my doctor doesn't support stuff like that, maybe that's why she's acting like that. I've been trying and trying. I'm 24 years old and I just want to live my life finally, it sucks.. Good luck tomorrow I hope it goes smoothly.

I live in Tacoma. Honestly I think my doctor doesn't support stuff like that, maybe that's why she's acting like that. I've been trying and trying. I'm 24 years old and I just want to live my life finally, it sucks.. Good luck tomorrow I hope it goes smoothly.

You can even talk to your gynecologist for a referral for bariatrics if your primary doesn't want to do it. Maybe try there. I grew up In T- Town lol. I would call your doctors office and tell them that you know for a fact weight loss surgery is covered on your insurance and you just need a referral, and you want the process started. That you have that right, They should have a referral coordinator in there office that handles that type of thing, try talking to them direct instead of your doctor. tell them you need it done and that your doctor is telling you its not covered but it is, id even write down the wac. or print a screen shot of the part that says it is covered. Dont take no for answer.

And if they do it and insurance says no, appeal it.

[Miss Mac 6,261]

I would call one of those bariatric centers mentioned by the others here and ask them if they would recommend a doctor who is bariatric - friendly.

[alysia.rush 24]

Here is a link to the letter that the university of Wa. sends with the stated Medicaid reqirments DSHS: to qualify for surgery.

http://www.uwmedicine.org/services/weight-loss-management/documents/DSHS-letter.pdf

Dear Patient Name,

We received a referral regarding your candidacy for weight loss surgery. This letter contains useful information

necessary to proceed with bariatric surgery at the University of Washington Medical Center. If you have medical coverage through any program with Washington Medicaid (Apple Health), including any managed care plan, all services involved in the bariatric surgery program REQUIRE PRIOR AUTHORIZATION. Current managed care organizations are Molina, CHPW, Amerigroup, United Health Care and Coordinated Care. The requirements for the bariatric surgery program are set by state law (WAC) and the University of Washington is required to follow them. If you start the program before receiving approval, the services will not be paid for. Please contact the insurance carrier for the required forms and guidelines.

Stage 1 (Preliminary Approval) To qualify for the bariatric surgery program the following requirements must be met. If you do not meet the requirements, you do not qualify for bariatric surgery under Medicaid rules and Washington Medicaid (Apple Health) will not pay for this type of treatment.  Age -You must be between the ages of 18 and 59.  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/Comorbidities – You must have ONE of the following conditions: o Diabetes Mellitus and/or; o Degenerative Joint Disease of a major weight-bearing joint(s), such as knees or hips, and you need joint replacement surgery immediately as soon as weight loss is achieved. o Other rare co-morbid conditions (such as pseudo tumor cerebri) in which there is medical evidence that bariatric surgery is medically necessary and the benefits of bariatric surgery outweigh the risk of surgical mortality.  You must NOT have multiple sclerosis (MS), which increases risk of mortality. While there are a number of other medical conditions that are often a result of obesity, they do not qualify for Washington Medicaid (Apple Health) approval. In the case that your condition does not satisfy the requirements, we recommend you continue to explore other options with your primary care provider (PCP) to find a non-surgical weight loss solution. Those who believe they meet the above criteria should contact their PCP who will request prior authorization for Stage 2 of the process. You and your PCP must be willing to work together

Stage 2 (Pre-Surgery Stage) You and your PCP must submit a completed the Prior Authorization forms determined by your HCA/Medicaid plan for Stage 2 and fax your medical records for review. Medicaid will review your request. You and your PCP will receive an official letter from Medicaid with the approval or denial of your request. If you are approved for stage 2, you will receive an approval letter. When/if you receive a letter of approval, READ IT CAREFULLY! You and your and PCP will need to complete each of the requirements including keeping a record of when you complete each requirement. Stage 2 of the Bariatric Surgery Program consists of evaluations and a supervised weight loss to prepare you to make lasting changes in nutrition and behavior needed for this surgery to succeed. Successful completion of the Stage 2 requirements will improve your health prior to surgery and encourage the lifestyle changes you will follow for the rest of your life. During the first 6 months of Stage 2 you will be required to:  meet with your health care provider once a month to review your progress;  meet with a dietician for counseling twice a month for at least 6 months (your provider will give you a referral) ;  lose at least 5% of your body weight based on a documented weight at a recent medical in a 6-month period of time. You must maintain your weight loss until the time of surgery;  keep a journal of active participation in the medically structured weight loss regimen. Additional insurance requirements may be necessary. Contact your insurance provider for a complete list of requirements. After 2 months into the 6 month supervised weight loss process your PCP can refer you to UW Medicine Weight Management Center to enter the patient in the Bariatric program and continue both programs simultaneously. The phone number is 206-598-2274; Fax 206-598- 6014. We will need the following items: Referral from your Primary Care provider, clinic notes outlining current co-morbidities and weight loss attempts and the Stage 2 authorization letter from Washington Medicaid (Apple Health). We will contact you to set up the following 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 you will be scheduled for a consultation with a surgeon who will evaluate you for the actual surgical procedure. Psychosocial Evaluation – Scheduled at the University of Washington Medical Center with a licensed psychiatrist or social worker. University of Washington Medical Center 1959 NE Pacific St. Box 356165, Seattle, WA 98195 Page: 3 Important! Keep your approval letter and complete the checklist you were sent. You and your PCP must keep a record that the requirements have been met. The completed provider or client checklist must be presented to the UW staff before Stage 3 will be requested. A copy of your journal of active participation may be requested as part of the Stage 3 authorization request.  You must continue your regular visits with a dietitian and Primary Care Provider to fulfill the Washington Medicaid (Apple Health), requirements while enrolled in our program.  You must maintain your weight loss till the time of surgery.  You must be non-smoking for two months prior to starting our program

Stage 3 (Authorization for Surgery) Following the process above, the UW Medicine Weight Loss Management Team at will complete the necessary steps for approval and scheduling for surgery. This process involves submitting all of the stage 2 records to your Washington Medicaid plan for final review. Once Washington Medicaid (Apple Health), has made a determination, you will receive an official letter informing you of your approval or denial for Stage 3. If approved, you will need to immediately fax the UW Medicine Weight Loss Management Team a copy of this approval letter to 206-598-6014. Once we receive a copy of this letter we can schedule your surgery. We hope that these guidelines clearly explain the process for you to obtain approval for bariatric surgery. If you have additional question, please contact our clinic at 206-598-2274. Sincerely, UW Medicine Weight Loss Management

[dreamingvsg 2]

Yeah I've gotten that letter in the mail UW was willing to work with me then told me to ask my doctor for a referral, my doctor had said that the referral lady said amerigroup said if it is was medically necessary and I'm assuming my dr told them no. Freaking stupid. My bmi is at the point where Medicaid would approve it and idk if Pcos is a co morbidity but yeah. I probably don't make sense. But honestly wanna give up

[Syl 153 35]

@@alysia.rush

Are you serious? I've been trying to get my doctor to work with me in getting me the gastric sleeve at UW. And they keep emailing me either saying amerigroup won't cover it or it's not medically necessary. I have the right bmi to have surgery and have pcos. So in my mind I think they didn't actually call. I really want to switch doctors so bad. I've been trying to get the sleeve and been getting knocked down each time. I wish I could send you the screen shots from my doctors office. My only hope is probably save and go to Mexico....

I am feeling the same way. Maybe we will meet in Mexico. did I say that?

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