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Medicaid paying for gastric bypass?

memphisgirl416
on 9/7/11 11:06 pm
Hi I was wondering if anyone that has been on SSI that has medicaid, has had gastric bypass and medicaid paid for it? I am in Mississippi and asked a year ago if MS medicaid paid for it and was told it didn't but I was wondering if your BMI is high enough or if it's a life and death situation will they go ahead and let you get it done? So I guess a better way to put the question I am trying to ask, is if anyone has lived in a state where medicaid does NOT pay for gastric bypass but has been able to get it done due to very high BMI or a life or death situation?
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.
Celia S.
on 9/7/11 11:17 pm - Grand Junction, CO
I live in Colorado and Medicaid pays for WLS here. They only cover the band and the bypass, I believe, but they do cover it! I had to have a documented medical need for it and be more than 100 lbs overweight. I also had to jump through a few more hoops than other people might have to.

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!

poet_kelly
on 9/7/11 11:22 pm - OH
I'm in Ohio and have both Medicare and Medicaid.  Medicare is my primary, Medicaid secondary.  They covered my surgery.

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.

View more of my photos at ObesityHelp.com          Kelly

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.

 

immafatgirl
on 9/7/11 11:25 pm - KY
it pays for it in ky. i think u have to have a high bmi or weight related health problems tho. i dont know why ur medicaid wont pay for yours since u are up to that weight and u want to live a better life. it should.!!! get on the phone and find out .. that way if they do. u can get started .
seashell6417
on 9/8/11 4:09 am, edited 9/8/11 4:10 am - Gaylord, MN
RNY on 02/13/09 with

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???

Tami

sontim77
on 9/8/11 4:13 am
RNY on 08/15/11 with
it pays in mass
findingmyself1994
on 9/8/11 4:45 am
RNY on 09/13/11 with
I am on Medicaid in MD and i Got approved for the Surgery, But my doctor is Awesome and so is his staff, they told me what i needed and i made sure i did it...I am scheduled for 9/13/11.
            
(deactivated member)
on 9/8/11 5:32 am
In Nebraska Medicaid does not, we did not pay for mine, but I'm on Soc. Sec. and my Medicare did pay for mine. I had to go to a certain facility, one of Bariatric Excellence, and would only cover the band or RNY. Good luck to you!
Randajo Smith
on 9/8/11 6:21 am - Yorkville, IL
RNY on 08/16/11 with
I LIVE IN ILLINIOS AND I HAVE BOTH MEDICARE AND MEDICAID. BUT IN ORDER FOR MEDICAID TO PAY IT HAS TO BE A SECONDARY INSURANCE NOT YOUR PRIMARY. I HAD GASTRIC BYPASS AUG 16TH AND BOTH MY INSURANCES PAID FOR IT. aND THE CENTER OF EXCELLENCE IS A VERY VERY GOOD ORGINIZATION. tHEY ARE ALL OVER THE UNITED STATES.
RANDAJO SMITH    
sarinajean
on 9/8/11 8:08 am - MA
I also was covered and on medicaid in Mass.