Lost don't known what to do???

shorty69 · May 31, 2007

:help:Need to have lap band do to my health but I only have Medacid for my Insurance I'm looking for Dr. how will take my Insurance or is willing to work with me to have this perciger done. But just remeber I'm a stay home mom.

Serena · June 16, 2007

Shorty

At least in some states Medicaid will pay if the program has earned a designation of Bariatric Center of Excellence. These are typically hospital-based programs. Be aware that many programs require an upfront, non-refundable program fee to cover the costs of evaluation, which no insurance will pay. My program charged $500, which covered the mental health eval, and meetings with the dietician and the nurse.

Good luck to you!

StacieM · June 19, 2007

Shorty
At least in some states Medicaid will pay if the program has earned a designation of Bariatric Center of Excellence. These are typically hospital-based programs. Be aware that many programs require an upfront, non-refundable program fee to cover the costs of evaluation, which no insurance will pay. My program charged $500, which covered the mental health eval, and meetings with the dietician and the nurse.

Good luck to you!

Serena... what state do you live in? I live in Ca and have medicaid... my doctor told me after reading the requirements I don'r even qualify for submission... I thin kthat is wrong and need some help trying to convince them otherwise. I have a BMI of 37 and have lots of co-morbidities and BAD family history... they should at least consider me.:clap2:

Serena · June 20, 2007

Stacie,

I live in Ohio. I know that Medi-Cal is very different than the Medicaid in the other states, but I actually thought that it was a little better. Medicare, which is a federal program, approves people with a BMI of 35 if they have the significant co-morbidities that you have.

I think that your best bet is to ask your physician to go ahead and submit you for consideration. If he is correct about the requirements, Medicaid will probably deny you, but you will have the right to appeal. I would be willing to help you write a persuasive appeal letter.

Maybe before that, you should call Legal Aid and find out if they can help you make an appeal to Medi-Cal. They probably would have a Medi-Cal handbook so you could find out exactly what the requirements are, and work from there.

You deserve help with getting healthy for your kids! With your bad family history and co-morbidities, you are bound to save Medi-Cal a load of money if you can undergo the surgery and avoid diabetes, heart disease etc. Take care.

Serena

StacieM · June 20, 2007

Serena thank you so much. I did spend awhile today on the phone with my insurance and could get no where as to their "guidelines" or requirements. I was told however to just have my doctor submit anyways and called and asked his office to do so. I hope he does. I thought about asking his office for the "info" they have but figure it would come with the denial letter. I did argue the fact that without allowing me to submit I could not appeal. So hopefully I get somewhere with this. I am not sure how long it will take for my doctor to submit and for them to deny or approve, but I think i have to see the surgeon somewhere in this process. I am going to call his office tomorrow and see what they recommend.

Oh and I will hold you to that persuasive letter.. .thanks... I know i will be mad and upset when writing it so I appreciate the help.

shorty69 · June 25, 2007

I live in San Antonio.Texas and ever time I go to the doctor all I'm told is that I'm going to have a heart attaick if I don't have the surgery because I am sick I'm going to the doctor tomorrow for my carpo in my arms & hands.:help:

Serena... what state do you live in? I live in Ca and have medicaid... my doctor told me after reading the requirements I don'r even qualify for submission... I thin kthat is wrong and need some help trying to convince them otherwise. I have a BMI of 37 and have lots of co-morbidities and BAD family history... they should at least consider me.:clap2:

StacieM · June 25, 2007

I live in San Antonio.Texas and ever time I go to the doctor all I'm told is that I'm going to have a heart attaick if I don't have the surgery because I am sick I'm going to the doctor tomorrow for my carpo in my arms & hands.:help:

Have you had your doctor make a referral to a bariatric surgeon or to a Weight Loss Doctor?

Serena · June 25, 2007

Shorty,

Search the web to get a listing of Bariatric Centers of Excellence in Texas. Call the one(s) near you to ask if the program accepts Medicaid, or check the hospital's website. You will probably have to attend their next informational seminar before you can get an appointment for a consultation.

As you can tell from reading all the posts, the approval process can take a while, but you will feel so much better once you take the first step. Let us know how it goes.