I have a question re: Medi-Cal and WLS coverage

Hi,

My name is Barbara and I now live in Raleigh NC, but I'm from San Jose CA. I have a sister and brother-in-law that live in Grass Valley that have come on hard times and are on Medi-Cal. Both are diabetic and obese. My dear BIL is SMO, around 400 lbs and has a host of comorbidities, so from a qualifying perspecitive I'm sure he would. I haven't seen my sister lately, but she would most likely qualify as a lightweight w/comorbidities since she is a type 2 diabetic as well.

I am visiting family here in Ca and their daughter stopped by. She hadn't seen me in person since I had my surgery and said she didn't know who the woman that opened the front door and hugged her was at first LOL. At any rate, as I was talking to her I told her that I'm so delighted with my size 6's and quality of life improvements, but if the only benefit had been the resolution of my diabetes, I'd still do it again. She said that her dad was interested in WLS, but thought that it was excluded by Medi-Cal. I told her I'd look into it. Do you have any information on Medi-Cal coverage of WLS or can you point me to a resource?

I appreciate your time and look forward to hearing from you.

Barbara
First Congrats on your size 6's!! Whoo-hoo! I know that Medi-cal requires the surgeon and the hospital to be a Center of Excellence. They may require extra tests and doctors to be seen.  I live in So Cal and the only Center of Excellence down here is Pacific Bariatric and Scripps Mercy Hospital in San Diego.

I would suggest that may be where they would want to start, Calling around and asking if they are a center of excellence. Then contact the medi-cal worker, to find out what hoops need to jumped.

Best of luck to your sister, brother in law, and all your family. They are lucky to have you looking out for them.

Hugs and Friendship,

Hi Michelle,

Thanks so much for your response and information. When my neice said that she didn't think it was covered, I told her I thought it was because it is in NC through NC Medicaid as well as through Medicare. I am aware of the need to go through a COE and will look into this some more for my siblings. 

I appreciate the compliments on the size 6's.

 

 

FYI to anyone reading the above post and who might be feeling discouraged--there are definitely more COE's in "SoCal" than just the one mentioned above--SoCal is a big place that is larger than just the San Diego area. (Los Angeles and OC most definitely have COE's). 

As far as which COEs take Medi-cal, I honestly don't know. It is possible that the one that the above poster has mentioned is the only COE that takes Medi-Cal in the SoCal area (though even that sounds hard to believe, SoCal being such a large geographic area). But again, if ALL you are looking for is a COE, SoCal definitely has more than just the one the above posting mentions.

Cynthia,

First my post wasn't ment to discourage anyone. I obviously mispoke when it came to name Pacific and Scripps as the only COE. I ment to say it was the only one that I knew of, personally. I went through Kaiser. I was responding to the poster. I, too, am sure there are many others, as I have heard of others with medi-cal recieving their surgery at other places. I just ment in order for it to be covered by medi-cal, it needs to be a COE. Maybe it would have been better if instead of you saying that you are sure there are other places and that I may discourage other people, you could have looked up some COE's and listed them. That would have been more helpful than tearing someone down for trying to help in the first place.

Hope you have a better day.

 

First my post wasn't ment to discourage anyone. 

Yes, I know--it was evident to me from reading your post that you were trying to be helpful and certainly weren't trying to discourage anyone. I was just worried that someone READING your post could have FELT discouraged if they thought that there was only 1 COE in all of SoCal. If you reread my post you will see that it is was addressed to a potential reader of your post, and my comments were not directed towards you. I'm certainly sorry if you felt I was policing you as that was not my intent.

I obviously mispoke when it came to name Pacific and Scripps as the only COE. I ment to say it was the only one that I knew of, personally...I just ment in order for it to be covered by medi-cal, it needs to be a COE.
 
I make errors too, so it is no big deal.  I simply wanted someone reading about COEs to know that there was more than just the one so they wouldn't feel discouraged. I remember how worried I was about getting my WLS covered -- I was nervuos about it, and I hope to prevent others from having to deal with unnecessary worry since I went through a lot of that myself. 

Maybe it would have been better if instead of you saying that you are sure there are other places and that I may discourage other people, ...

(Trying not to be offended) Okay, now I'm thoroughly confused. You're trying to help and provided good info about the requirement of Medi-Cal to use a COE. That's good. I'm ALSO trying to help by providing additional information to someone seeking WLS--but this is tearing you down? My message was addressed to someone seeking WLS, clarifying something in your post that I thought might cause others to loose hope (I know I would have if I had read that SoCal only had 1 COE). So I am not sure how my (perhaps feeble) attempt to help (by clearing up something that I thought was unclear in your post--as you said, an honest mistake on your part--it is readily apparent that you were NOT trying to mislead anyone) is tearing you down?

I'm certainly sorry that you felt I was attacking you, but it wasn't my intent to tear you down.

...you could have looked up some COE's and listed them. (REALLY trying to not be offended)

There is an extensive list of Medi-Cal doctors posted as a sticky at the top of the CA boards. What I felt it was important to do was to tell people that there is more than 1 COE in SoCal, and I accomplished that.

That would have been more helpful than tearing someone down for trying to help in the first place

Again, I wasn't trying to tear you down. SOrry you felt otherwise. Hopefully my message will help clear up things for someone who may have through COE's are hard to come by in our area.

And at least hopefully my effort at replying to you here will put to rest the idea that I was trying to tear you down. Honestly, my message was about helping someone who might have been confused by what you had said, that was my goal--not to make you feel bad.

Sorry you were offended.

Hi there!!!  I don't usually answer on this subject, but I feel for your situation with your family members.  Medi-Cal DOES pay for WLS.  I have Medi-Cal and i hadit done through Kaiser.  I had it done at the place the last poster mentioned in San Diego.

Hi Andrea,

Thanks so much for you response. I can't tell you how much I appreciate the information and support I get from the OH family. 

Congratulations on your success.