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Medicaid questions. Newbie.

AC3

By AC3, in Insurance & Financing

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AC3    51

AC3
Posted

Hi! I'm new here and I'm just seeing if anyone has had the gastric sleeve and has Medicaid? How long was your process? I meet with my surgeon on the 10th and I'm nervous/anxious about this whole process. My BMI is like 38.2 but I don't have diabetes/HIgh BP or anything like that. I just have arthritis in my back, bad knees and bad ankles. Did you get approved? Any kind of feed back would help!

Thank you!

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reducer623    137

reducer623
Posted

If you have a high BMI w/ or w/o complications they will cover it. If you have low BMI with a co-morbidity, they will also cover it. With a BMI of 38, you'll be fine . Good luck!

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WitchySar    244

WitchySar
Posted

I don't know if it varies by state. I have Medicaid and I'm going for the sleeve. Here in Colorado it's covered for BMI above 35 with sepcific comorbidities, and above 40 without one.

According to the info I have under 40 BMI has to have one of the following:

1. Severe cardiac disease

2. Type 2 diabetes

3. Obstructive sleep apnea or other respiratory disease, such as chronic asthma

4. Pseudo-tumor cerebri

5. Hypertension

6. Hyperlipidemia

7. severe joint or disc disease that interferes with daily functioning

8. Intertriginous soft-tissue infections, nonalcoholic steatohepatitis, stress urinary incontinence, recurrent or persistent venous stasis disease, or significant impairment in Activities of Daily Living (ADL).

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Allison Congdon    2

Allison Congdon
Posted

im in ct and have medicaid they required 6 mo with a dietian and 3 support groups attendence along with pulmonary cardiac clearence and if you are diabetic i was required to have an aic under 7 for approval the process took me 14 month i started in april of 2015 and was sleved on june 6 2016

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1800martina    7

1800martina
Posted

How long did your whole process take tho? Like, for your appts? What's your BMI? Do you have any major health issues tho?

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I began this process early March 2016, before then I didn't even know what gastric surgery was. My BMI was 44 and I am prediabetic.

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AC3    51

AC3
Posted

im in ct and have medicaid they required 6 mo with a dietian and 3 support groups attendence along with pulmonary cardiac clearence and if you are diabetic i was required to have an aic under 7 for approval the process took me 14 month i started in april of 2015 and was sleved on june 6 2016

Goodness! That's a long time! I met with my surgeon today and he said the process is 3 months. Well, 3 months with the dietician. So I'm looking at sometime in Nov!

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AC3    51

AC3
Posted

How long did your whole process take tho? Like, for your appts? What's your BMI? Do you have any major health issues tho?

Sent from my iPhone using the BariatricPal App

I began this process early March 2016, before then I didn't even know what gastric surgery was. My BMI was 44 and I am prediabetic.

Sent from my SM-N920P using the BariatricPal App

Oh ok. Yeah, he said 3 months with dietician. Lol. I'm going to try and set up all my appts I need to do right after the first visit with the dietician.

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Gordita81    98

Gordita81
Posted

I am also on state medical in RI. They required 4 months with nut, BMI of 40 w/o comorbidities or 35 with. Also multiple previous documented failed Weight-loss attempts. This is my second time through the process. My first attempt was denied based on insufficient documented attempts. My BMI was 40 at the time and I am pre-diabetic. Being pre-diabetic is not considered a comorbidity. Now, on my 2nd attempt, I was approved. My BMI is now 44. Because each state offers there own medical plans, the requirements do vary. Good luck to you!

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AC3    51

AC3
Posted

I am also on state medical in RI. They required 4 months with nut, BMI of 40 w/o comorbidities or 35 with. Also multiple previous documented failed Weight-loss attempts. This is my second time through the process. My first attempt was denied based on insufficient documented attempts. My BMI was 40 at the time and I am pre-diabetic. Being pre-diabetic is not considered a comorbidity. Now, on my 2nd attempt, I was approved. My BMI is now 44. Because each state offers there own medical plans, the requirements do vary. Good luck to you!

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Thank you! He told me my insurance requires 3 months with the dietician and he didn't say anything else really. He told me that he could definitely help me and that's I'd look weight fast. I'm 5ft 3 and about 225. He just asked me questions and I told him I have bad arthritis in my knees, back, ankles and hips. I just hope I get approved after doing all of this. Lol. Good luck to you as well!

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