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Approved! Washington State Apple Health (Molina Medicaid)

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I was approved today to begin Stage 2 of Molina's bariatric program. I am a 5'5", 309 pound 35 year old female. My BMI is 50. I have one co-morbidity of high blood pressure, and a doctor who believes that WLS is medically necessary.

I also have fibromyalgia, but I do not believe they take that into consideration when it comes to medicaid.

My doctor referred me to the required orientation for Dec. 16th, 2015. I was approved today, January 11th, 2016.

I have to complete these requirements by July 4th, 2016

12 dietician visits

12 physical therapy visits

bariatric psych eval ( or my last years records from my counselor)

EKG

I live in Clarkston, WA. My PCP Tamara Bruns (Nurse) got me into the program. I will be having surgery at Rockwood Surgical Group in Spokane, WA.

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Oh I still have a ton of stuff to do, im just getting my foot in the door with the university. Havent been with any of the doctors there yet. Im not too far in too this ordeal yet. My referring doctor said I might get approved for the surgery ( and be done with all the steps during the 6 months in Dec)

I dont really have any advise, I read alot and do research online about as much as I can . Ive started keeping a log of what I eat. I dont do it every day now. I did for a month when I was being really strict on my diet. That was helpful to go back to and look at too see what I ate and how much that helped me kick start my weight loss. Ive currently lost 21 lbs since started.

I wonder if since you lost so much weight they wont approve you for stage 3 they may say you are doing well on your own. . I know you only have to lose 5 percent to qualify.

Molina told me that I just have to do the 3 twelves, 12 dietitian 12 physical therapy and 12 behavior therapy appointments

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Molina is making you do 12 physical therapy and 12 behavior therapy appointments on top of 12 Nuts?

Im on Amerigroup they said 12 nut apps and 6 doc, get a pysch eval, keep an activity log, and thats all other than what all the University of Washing will be doing as far as there testings and such, my nut said I will meet with a nut over there twice and a physical therapist once I think, and then another pysch eval over there possibly?

  • Author

Kim, I went from approval to surgery in 3 months. At Rockwood in Spokane, they can fast track you as long as you have half of your 12 pt/NUT/counseling visits done and half of your 6 Dr. Visits done, your 5% lost, EKG and Psych Eval completed.

I'm on Molina and I should be done with my 36 total appointments in 6-8 weeks, I need to loose 16lbs then I'm good to go

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  • Author

OH BTW...Rockwood now has a plastic surgeon that can and will take Apple Health referrals...and if you have loose skin had any kind of rash, Rockwood will refer you two years after sleeve surgery!

I wonder if since you lost so much weight they wont approve you for stage 3 they may say you are doing well on your own. . I know you only have to lose 5 percent to qualify.

Oh I still have a ton of stuff to do, im just getting my foot in the door with the university. Havent been with any of the doctors there yet. Im not too far in too this ordeal yet. My referring doctor said I might get approved for the surgery ( and be done with all the steps during the 6 months in Dec)

I dont really have any advise, I read alot and do research online about as much as I can . Ive started keeping a log of what I eat. I dont do it every day now. I did for a month when I was being really strict on my diet. That was helpful to go back to and look at too see what I ate and how much that helped me kick start my weight loss. Ive currently lost 21 lbs since started.

I hope not, Ive lost close to 100 lbs on my own twice in my life before, but I always gained it back within a year, my referring doc said to keep going with the weight loss and my Nut said I can maintain the weight but has be doing more exerciser.

  • 2 weeks later...

Any of you ladies know if you HAVE to have at least one comorbidity with Medicaid Molina? I spoke to a representative at Rockwood and she says you donot... I'm wondering if she thought I had regular Molina..

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I got my approval to start stage 2 on June 1st, I'm excited

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I got my approval on June 1st as well! Same insurance too!! I'm beyond excited to begin this journey!! CHEERS!

Are going to be getting it done at UW?

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Are going to be getting it done at UW?

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Yes I am and I'm happy about it. I have heard rave reviews about UW and the care that people got while there. I live in Vancouver, so it's going to be a bit of a drive, but I love Seattle, so I'll probably go up a day early just relax before the big day! If all goes well it will be December! What a way to kick off 2017!!!

I'm super excited about it can I message you?

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im gonna get mine done around Dec too, but I have two kids, So I might wait till after Christmas. Also At U.W excited. I am on Amerigroup Medicaid.

Sweet!!!! Maybe we will see other in the hospital

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