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Looking for guidance on surgery with Medicaid.



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Hi there! I’m 24, 5’7 and 250 lbs. I’ve been trying to lose weight on my own since I was about 15 with little to no success. I’m currently pre-diabetic, and taking atenolol for hypertension.

I’m young, and low income. My insurance is Medicaid through the state of Arizona, and after calling my insurance to ask about the process of getting a gastric sleeve, they were unfortunately not very helpful. I’d love to hear your complete process from consultations to receiving your surgery while being covered by Medicaid.

I do know that they require a BMI of 40, or 35 (I think) with diabetes or high blood pressure. Either way, I am just about a BMI of 40.

thanks so much in advance!!

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Medicaid typically requires 6 months of documented medically supervised weight loss attempts with your doctor, bmi of 40 or 35 with at least 2 comorbidities, pass an ekg, blood work, and pass a psych eval before they will approve the surgery. They may also require a referral to a bariatric surgeon from your primary doc. They will also require a letter from your primary doctor approving you to have the surgery. All of that gets submitted to Medicaid by the bariatric surgeon and then Medicaid decides if they will approve it or not. If they deny it, they'll usually tell you why and you can either do whatever else they need you to do or appeal it if you already have it done.

That's all I can think of. I actually originally looked into bariatric surgery way back when I was on Medicaid, but ended up not doing it. Once I started my previous job and got BCBS, I looked into it again and ended up doing it. When I had my revision a year later, I was changing jobs and in between insurance and back on Medicaid (if the revision if for complications and not failed weight loss, they tend to approve the revision really fast - in my case, it was 72 hours, if it's for failed weight loss, you basically have to start everything all over again as if you're doing the surgery from scratch, and all the previous requirements are back in place). Now I'm at my current job (dream job) and have United Health Care. I hope this helps somewhat!

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So my bestie who is in the process has medi-cal through partnership and her primary is Kaiser. Kaiser approved her sent all her info in. Their process is a goal weight, psych eval, blood work and meeting with dietician which she is almost done with the process and when its all said done it'll have been 2months ish. IDK if that is anything like medicaid.

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