ALL GEORGIA AMERIGROUP MEDICAID MEMBERS
GA Medicaid and all its replacements do cover bariatric surgery, if found medically necessary. I work in a bariatric surgery office (I do all the insurance precerts). Some offices accept some forms of medicaid and not others. For example, my office, also in Savannah, does not accept GA Medicaid, but accepts Wellcare medicaid and Amerigroup Medicaid. Of the two, I find Amerigroup easier and quicker to obtain approvals for surgery. There are some out of pocket costs associated with our program that is not covered by the insurance, but we have found them necessary for success. Wellcare Medicaid requires a 6 month diet and exercise program that you attend monthly with your primary care physician or another provider other than the bariatric surgeon. Amerigroup does not have this requirement, but wants a detailed documentation of what you have tried to do in the past for weight loss. They do both require a psychological evaluation and clearance. They also want to see that you have had all your questions answered and that you have a plan for after surgery for followup and support. We have experienced some difficulty in getting both Amerigroup and Wellcare to pay for the psychological evaluation, as others have stated above.
I have Amerigroup and currently considering a revision of my gastric bypass. What types of clearances will I need to have for an approval and generally how long is the process? I have already seen a nutritionist and from the way she was explaining things, all I need now is the approval of an EGD then surgery. Is this correct?
I have Amerigroup and for some reason they are now saying that 6 month supervised weight loss visits are now required. I was denied the first time because I didn't have documentation showing the 6 months. Month later I was denied again with documentation showing the 6 month supervision. Any idea why and what I can do?
@sarabelle0808.
Hi Sara, I know this is an old post but I am crossing my finger that you see question. Does Amerigroup 6 month supervise diet with the nutritionist? I had a total of 6 supervised diet within 7 months. I missed 1 visit (I had CareSource but switched to Amerigroup) I was just notfied by the coordinator that I need to start all over again because it has to be 6 consequently visit & I can't do another 6 months I will no longer have Amerigroup. I really hope she made a mistake. Thanks in advance.
no because i had 2yrs of medical documented attempts. such as going to a weight loss clinic it shows dates and weight lost/gained plus doctor visits and gym membership. but without it i may have had to do a 3 or 6mth diet with a dietician. i only seen the dietician for about 6-8wks but i had to do the other testings which took about that long as well so it was doable
