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Need help... Washington State

dreamingvsg

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dreamingvsg    2

dreamingvsg
Posted

I have amerigroup. With medicaid. I live in Tacoma, Washington. I don't know if my doctor is lazy and isn't really sending in referrals for me. But I only know of one hospital that will accept Medicaid for weight loss surgery. I've seen so many ladies on here saying they been approved and already on their journey starting December and it just frustrates me because I've been wanting this since I was 17. I am almost 25 and this would be the best present ever. My doctor is trying to say amerigroup said it has to be medically necessary. I have pcos and my bmi matches the number for surgery. I know I may not make sense. Maybe it's my doctor. IDK. Does anyone have any advice for me? Any information. Please help.

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Shauny85    31

Shauny85
Posted

I have amerigroup. With medicaid. I live in Tacoma, Washington. I don't know if my doctor is lazy and isn't really sending in referrals for me. But I only know of one hospital that will accept Medicaid for weight loss surgery. I've seen so many ladies on here saying they been approved and already on their journey starting December and it just frustrates me because I've been wanting this since I was 17. I am almost 25 and this would be the best present ever. My doctor is trying to say amerigroup said it has to be medically necessary. I have pcos and my bmi matches the number for surgery. I know I may not make sense. Maybe it's my doctor. IDK. Does anyone have any advice for me? Any information. Please help.

I live in kent. But what I did was have my Dr send my referral in to the Insurance company. Which is the apple care once he did that I called them after a few days to see if they got my referral also I learned from the insurance company that you primary care Dr doesn't have to be the one to send in your referral. You can have any other Dr related to your health care like if you go to physical therapy they can send it in. But as the end of the day if you want your Dr. To do it just explain to him y you need it or see a different Dr. My pca is in federal way he sent in the referral after I spoke to him about why I did the surgery.. If you want to DM me I can give you his number. He's located by the st Francis hospital.

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surviving5    32

surviving5
Posted

I have Molina but I would suggest calling your insurance and ask what they require. With molina pcos wouldnt be a comorbidity. Your insurance may be different. Molina requires BMI of 35 and above and 2 Comorbiditys or BMI of 40 with one. ( although the one depends on who you ask). Do your research. I went online and got the stage 2 paper work for Molina bariatric surgery and printed it out. I took it too my docs so they had it and knew what was needed. I got tired of waiting on everyone else. The only hospital that can do the surgery for this side of the mnt and medicaid is UW. So make sure you look into that as well.

Take everything you find to your doc and tell them " This is what my insurance wants for WLS. I have this this and this. I qualify. Please fill this out and submit it."


Good luck!

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dreamingvsg    2

dreamingvsg
Posted

Okay. I just changed my insurance to Molina like 20 minutes ago. What are the steps I need to take? I've seen the Molina Healthcare bariatric request online. It says stage 2 approval though. Should I make an appointment with my pcp and go over it? Or should I contact UW first? I'm sorry ladies. Also. The only thing I really have is PCOS and my bmi is 47. So idk if I would qualify with MOLINA. Amerigroup denied me. I appreciate all the replies, I truly do. Ive been wanting this since I was 17. I'm about to be 25 November 18th and I just want to be healthy and happy. I've tried everything. The more information I can get the better. ❤❤

Sent from my N9518 using the BariatricPal App

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Chicken Lady    102

Chicken Lady
Posted

With a BMI of 47 you do not need any comorbidities with Molina. My BMI was 45 and I did not require any comorbidities for surgery. Molina required six months waiting period. During that six months I had to lose 5% of my bodyweight, go to 12 nutrition appointments, 12 visits to PT and 12 psychology visits and a monthly weigh in with my dr.

During month five of that I was finally able to go to UW to meet with the team to start their prerequisites. It took me about 10 months start to finish from my doctor starting the process with my insurance company untill surgery day.

HW - 283

SW- 238

CW- ?

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • BeanitoDiego

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      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
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