Revision help???

Does anyone know about having revision surgery in the state of Iowa?  I am really wanting to get this done.  I have Medicaid and they paid for my surgery 4 years ago and am wondering if they will pay for it again?  Also, I wonder if you have to go through another 6-month supervised diet?  Any and all help would be appreciated, thanks!

Tonya

I'm not sure if I will be of much help. What type of revision are you looking at?  I know the most recent info I read on rulings from CMS over medicare/medicaid at the national level still consider laproscopic gastric sleeve to be experimental/not proven and not a covered benefit.  I am not on Medicaid but I know I was curious a whle back on what would happen if I needed/wanted a revision, would my insurance pay for it and for my insurance you have to meet the same criteria that you had to meet the first time around, including the BMI criteria and supervised diet.

Thanks for your response Cheryl.  According to the bariatric center in Grinnell..my insurance will pay for a revision if its deemed medically necessary.  They require the same thing as the first time around, BMI over 35 w/ co-morbs or BMI of 40 or greater.  I had to do a 6 month supervised diet as well, but the lady told me in this surgeon's office that if there is evidence that my stoma or something is wrong with my stomach, then that may be cause enough for them to waive the 6 month supervised diet since that is not something a diet can fix, only surgery could.  I have an appointment of June 13, so I am not sure if they will do a test then or not.  Hopefully they do and can see if anything is wrong.  Ideally, I don't want to do the diet all over again, but I will if need be.  Anyway, I appreciate you getting back to me.

 

Have a nice weekend,

 

Tonya 

 The Iowa Medicaid program is moving forward with various cost containment strategies as directed in HF 649, passed by the Iowa legislature this year. All of these will be detailed in Informational Letters sent out to Medicaid providers and most are effective August 1 of this year. Some of the strategies relevant to Iowa physicians treating Medicaid members:

1. There will be a 15-day supply limit on initial fill of select prescriptions that have high side effect profiles, high discontinuation rates, or frequent dose adjustments.

2. Medicaid will no longer cover drugs used to promote weight loss or prescription drugs used for symptomatic relief of cough and cold.

3. Medicaid will eliminate coverage for bariatric surgery for the treatment of morbid obesity.

It looks like Iowa Medicaid will stop their coverage of the surgeries in August.  I think if you could get it approved before aug then you could have it but definately not after

Sorry

Pup

Hi,

  I'm very interested in knowing exactly where you found this information from and what kind of credible source you can provide.  I know Iowa Medicaid does not currently cover weight loss prescription drugs.  I know this because I've called and asked the IME member number and the physician I was interested in having them prescribe them to me.  So that #2 is not totally correct.  Also, are you saying all bariatric surgeon's in Iowa should have knowledge this at present time?  Because August 1st is in just two weeks.  Anyway, if you could let me know the source of this information and where I might be able to find it, it would be much appreciated.  

 

 

Thanks,

    Tonya

OOPS- I might have been a year off in what I read- sorry if I freaked you out.  It looks like it took the Gastric bypass restriction off.  I'm very sorry I freaked you out.

How much weight have you gained?

 It is possible to lose the weight again without surgery- even if things have "stretched"  You have to go back to following the rules and eating like you did post op.  You still have malabsorption (no matter what some people say)

Stay FAR away from carbs and start the shakes again.

I think with how much we all pay in taxes medicaid will only pay if it is medically necessary-not just a weight gain , the gain has to be causing medical problems not just a change in clothing size.

Good luck in your weight loss

Pup

Thanks.