Medicaid paying for gastric bypass?
on 9/7/11 11:06 pm
I just got approved for SSI after two years fighting for it and WLS is only hope for ever living a normal life again. I have several health problems which has caused my weight to get too high and along with having lymphedema that is very bad it has made it to where I can no longer walk more than a few feet to get to a from the bathroom back to the bed. I do what exercise I can while laying/sitting but being over 600 lbs now, it isn't helping much.
I wish I knew what to tell you about Mississippi's Medicaid rules when it comes to covering WLS ... Sorry. When you called and asked, did you ask about a specific procedure or did you ask about WLS in general?
Wishing you the best of luck!
If Medicaid in Mississippi doesn't cover it, though, then they don't cover it. It wouldn't matter how high your BMI is. If they do cover it, there will be criteria you have to meet, like a BMI of 40 or above or whatever their rules are. They won't just cover it for anyone that wants it, you have to meet the criteria.
If you have SSI, you'll be eligible for Medicare after two years. I know that seems like a long time to wait, but they will cover WLS. They only cover 80% of most things so you would have to pay the rest, though.
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
I believe it is covered under the state Medicaid plan here in MN. Check w/ Medicare, too. I believe the once a person has been determined to be disabled for one year by the Social Security Administration (you are considered disabled if you are receiving SSI) they become eligible for Medicare. The "start" date of your disability would be the date they began payment, not the date you received your first check. That means if you received back payment for six months while you were in the midst of an appeal, your "start" date of your disability would be six months before you even received your first check. At the point you are eligible for Medicare it becomes your primary insurance and Medicaid picks up covered services that are not paid for by Medicare. Maybe WLS will be an option the once you hit that one year mark and become eligible for Medicare???
I also live in Mass.
Did u have to do 6 months on a medically supervised diet plan? And do u know if having a BMI of 40 is enough or do u still have to have a commodity? I Have 3 commodities but 2 of them is at level 1 and controlled with meds so I don't think they will count. The other one is sleep apnea but Medicare won't recogonize (spelling?) it because I only have it in rem sleep and they say it has to be all night. If I lose more than 10 pounds I will lose a BMI of 40 and don't think I will qualify. If u can give me any info that would be great.
on 9/8/11 9:04 am
My BMI is 50-51 and have sleep apnea, so hopefully I will get approved. I also asked my surgerons office and they take that insurance and they have all the requirements that I need to get done and so far my "last" appointment is 9/30/2011 and hopefully I will find out if I am approved before the end of October. Hope this helps
on 1/9/12 8:58 am
on 5/8/12 11:26 pm