Help please?!!

[daylany 38]

Does anyone knows when they tell you if you approve or not for the surgery. With medicaid coverage???!!! They set my surgery date for march 12 but they are going to send all the information to my insurance first. any help please im so scared that i might not get approved. I have a BMI of 37 severe joint pain an a history of tachycardia and hospitalization because of tachycardia.

[kakatlady612 1,053]

Probably depends on your state. Rulings are not always uniform. Yes Medicaid. Does approve but it does depend on your comorbities and probably your BMI also. Were you at this weight when you started? Say you were 270 at the start even if you went down to 250 it would still be okay. Hopefully your surgeon or some of his staff know where to tweak things for the maximum benefit for you. Good luck,on your weight loss journey.

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[AceBlaque 17]

Good morning, what tests did your Medicaid request you do. What tests did your doctor/surgical team have you complete?

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[Creekimp13 5,838]

Good luck, Ace. Hope your approval comes through soon and puts your mind at ease.

[daylany 38]

Good morning, what tests did your Medicaid request you do. What tests did your doctor/surgical team have you complete?

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They request me a 4 months diet supervision. And a bunch of test i even got a stress test on my heart donde.

[daylany 38]

They request me a 4 months diet supervision. And a bunch of test i even got a stress test on my heart donde.

Done*

[daylany 38]

Good luck, Ace. Hope your approval comes through soon and puts your mind at ease.

Thank you im setting my mind very positive because i pray to the lord saying that my body needs a second chance.

[daylany 38]

Probably depends on your state. Rulings are not always uniform. Yes Medicaid. Does approve but it does depend on your comorbities and probably your BMI also. Were you at this weight when you started? Say you were 270 at the start even if you went down to 250 it would still be okay. Hopefully your surgeon or some of his staff know where to tweak things for the maximum benefit for you. Good luck,on your weight loss journey.

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Hopefully yes. And i started with a BMI of 38 and thank you for your good wishes.

[AceBlaque 17]

I tried sending this to you as a message but I was unsuccessful so I'm reposting here. It was something I shared here on BP with some facing approval. Although im not a 'know it all' anything that I know that may help you, i'll be happy to share. If you have any questions let me know.

I shared/posted this a few weeks ago with someone facing insurance approval too:

I had a sleeve gasterectomy in spring of 2015 and had no issues getting approved. In spring of 2017, my original surgeon and I saw that a full duodenal switch was needed for the absorption component so yhe process for approval began again...EGD, psychological evaluation, PCP visits and approval etc. Since BCBS only covered one bariatric procedure per lifetime, The situation with the second surgery is that it needed to be proven to be medically necessary and that I had been compliant with the sleeve gasterectomy in 2015. After the completion of my tests and visits, my package was submitted to my insurance company. As you guessed it, DENIED. I knew I had to act quickly since it was denied in the fall, this meant my deductibles has been met and in order to not have to pay them again in 2018, I needed to try to push for approval before 2017 ended. I knew that the appeal could take longer than I would need and after what decision I would be given, I would either have to have the surgery in 2018(deductible) or have to start the process from the beginning. Although I was frustrated about the denial, I decided to start doing what I knew to do, fight. You see I work for a medical insurance provider and advocate daily for members to receive the care that is needed, be it from physicians or the insurance company. I had assisted many members before in getting various approvals for different treatments that was needed to better their life. I went over all the things that I knew a review board and medical director would want to see/know before granting me a 2nd opportunity. Upon doing this I realized that my surgical team did not fit my needs this time around and to appeal the initial denial would be pointless since the evidence/tests needed for the insurance approval were not done by my original surgeon. I did additional research and found a surgeon in Texas that was well credentialed, accepted my insurance and also did initial appointments by phone since I was a patient from another state. After reviewing ALL of my medical history that was sent to him and discussing the prior denial, we forged forward. After phone 'visits' I was scheduled for an EGD with this doctor along with a 3 part stress test(breathing, legs and heart to check for clotting and exercise)...during the EGD I was also given a ultrasound of the gallbladder. This doctor was extremely thorough and was making sure that I was given every possible chance for the insurance to not deny me. When the package was submitted after all of the tests, I made sure to tell my insurance coordinator at the surgeons office additional things I wanted included such as my fitness gym contract, diseased gallbladder ultrasound, receipt from latest pcp appointment(that insurance company didn't show in their records)...I knew I had a better chance at approval if BCBS saw that not only was I being compliant but that I needed a cholesctomy(gallbladder removal) and that I would pursue the 2nd surgery until it was granted. With the cost of treating my comorbities, I'm sure the insurance saw that it was less expensive to grant the surgery than it was to treat the ailments that existed bc of my weight. By the amazing powers that God put in place, I was granted the second opportunity to change my life. My surgery took place December 14, 2017. Prior to surgery my co-morbidities were high cholesterol, hypertension, diabetes(with injections daily), edema in lower extremities. Please don't give up!!! My apologies for the long reply but I hope it helps someone that needs the strength to keep fighting.

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[daylany 38]

I tried sending this to you as a message but I was unsuccessful so I'm reposting here. It was something I shared here on BP with some facing approval. Although im not a 'know it all' anything that I know that may help you, i'll be happy to share. If you have any questions let me know.

I shared/posted this a few weeks ago with someone facing insurance approval too:

I had a sleeve gasterectomy in spring of 2015 and had no issues getting approved. In spring of 2017, my original surgeon and I saw that a full duodenal switch was needed for the absorption component so yhe process for approval began again...EGD, psychological evaluation, PCP visits and approval etc. Since BCBS only covered one bariatric procedure per lifetime, The situation with the second surgery is that it needed to be proven to be medically necessary and that I had been compliant with the sleeve gasterectomy in 2015. After the completion of my tests and visits, my package was submitted to my insurance company. As you guessed it, DENIED. I knew I had to act quickly since it was denied in the fall, this meant my deductibles has been met and in order to not have to pay them again in 2018, I needed to try to push for approval before 2017 ended. I knew that the appeal could take longer than I would need and after what decision I would be given, I would either have to have the surgery in 2018(deductible) or have to start the process from the beginning. Although I was frustrated about the denial, I decided to start doing what I knew to do, fight. You see I work for a medical insurance provider and advocate daily for members to receive the care that is needed, be it from physicians or the insurance company. I had assisted many members before in getting various approvals for different treatments that was needed to better their life. I went over all the things that I knew a review board and medical director would want to see/know before granting me a 2nd opportunity. Upon doing this I realized that my surgical team did not fit my needs this time around and to appeal the initial denial would be pointless since the evidence/tests needed for the insurance approval were not done by my original surgeon. I did additional research and found a surgeon in Texas that was well credentialed, accepted my insurance and also did initial appointments by phone since I was a patient from another state. After reviewing ALL of my medical history that was sent to him and discussing the prior denial, we forged forward. After phone 'visits' I was scheduled for an EGD with this doctor along with a 3 part stress test(breathing, legs and heart to check for clotting and exercise)...during the EGD I was also given a ultrasound of the gallbladder. This doctor was extremely thorough and was making sure that I was given every possible chance for the insurance to not deny me. When the package was submitted after all of the tests, I made sure to tell my insurance coordinator at the surgeons office additional things I wanted included such as my fitness gym contract, diseased gallbladder ultrasound, receipt from latest pcp appointment(that insurance company didn't show in their records)...I knew I had a better chance at approval if BCBS saw that not only was I being compliant but that I needed a cholesctomy(gallbladder removal) and that I would pursue the 2nd surgery until it was granted. With the cost of treating my comorbities, I'm sure the insurance saw that it was less expensive to grant the surgery than it was to treat the ailments that existed bc of my weight. By the amazing powers that God put in place, I was granted the second opportunity to change my life. My surgery took place December 14, 2017. Prior to surgery my co-morbidities were high cholesterol, hypertension, diabetes(with injections daily), edema in lower extremities. Please don't give up!!! My apologies for the long reply but I hope it helps someone that needs the strength to keep fighting.

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Thank you very much it helps a-lot to know that someone else was almost in the same situation as i am and you succeeded thanks to the lord. I was about to give up and to forget everything about the surgery and just don’t keep showing up to my next visit but you know what im not giving up until I’ve donde what i have to do. I will leave this in hands of my lord because he knows that i deserve a second chance in life because being obese and having complications for the obesity is not life.

[ronda81 20]

They set my date and my approval came 10 days before

[AceBlaque 17]

Thank you very much it helps a-lot to know that someone else was almost in the same situation as i am and you succeeded thanks to the lord. I was about to give up and to forget everything about the surgery and just don’t keep showing up to my next visit but you know what im not giving up until I’ve donde what i have to do. I will leave this in hands of my lord because he knows that i deserve a second chance in life because being obese and having complications for the obesity is not life.


Yes you do!! Please don't give up, it seems discouraging but don't give up...Any road blocks you hit are only temporary and we are all in this fight together! Stay strong and know that you aren't alone. If there is anything that my experiences have taught me is that God is always working for our good...you deserve to live the best healthier life possible and your struggles will equip you to help give someone else encouragement when they are facing the storms too. People here on Bariatric Pal don't know it but they have been my BIGGEST 'Patient Advocates' and have helped me by sharing their stories which created in me a burn to keep fighting...if there's any information that I can give to help, don't hesitate to reach out, we all want to see you get the second chance that you deserve!

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