VSG WITH MEDICAID. I'M CONFUSED, PLEASE HELP!!!

CWSBBYMUTHAOF3
on 5/5/14 1:24 pm

Hi, 

I went to my weight loss seminar last week on May 1st. I am scheduled for my consultation for May 8th. I have medicaid and have some questions on the process. I know you have to have a BMI of 40, which I do, but barely. I am 220 lbs and 5'1". I was wondering if there were any cases where medicaid would approve you in less than 6 months for the surgery or if that was the minimum amount of time. Also, do you have to lose weight during your visits with the nutritionist? I am afraid to lose any more than 2 lbs because that would make me fall under the BMI requirements, but I am also afraid that they will turn me away for not losing. I am so confused. I am a smoker and I am hoping that when I quit smoking within the next month I may gain some weight and then I can lose that to show I am capable of dieting, but I heard somewhere that sometimes they want you to lose 10% of your body fat on your own which would put me at a 38 BMI. Any help would be appreciated!

Thanks,

Nicole

poet_kelly
on 5/5/14 5:51 pm - OH

Medicaid varies from state to state.  You really need to call the number on your card and find out what their rules and regulations are.  If they require a six month supervised diet, then most likely they will not approve surgery in less than six months.  But you can call and ask if there are any exceptions.

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.

 

CWSBBYMUTHAOF3
on 5/5/14 10:09 pm

Sorry I am from Louisiana and I was trying to post in the Louisiana forum but I'm new here and still trying to learn my way around. Thank you for your answer! 

pebtash
on 5/5/14 10:55 pm
VSG on 11/25/14

Hi I have Medicare not Medicaid and from what I have seen Medicare requires a 6 month medically supervised diet and Medicaid requires a 3 month one not sure if this is true but when I called Medicare they didn't seem to know very much about anything. My PCP told me to go to my first appointment and talk to them since they deal with this all the time. So my first appointment is May 16th unless there is a cancelation. There was one last week but I was on vacation.  I also was in the same situation that you are in my BMI was at a 40 and my comorbidities are borderline then I went up to a 40.5 and since I have to do a 6 month medically supervised diet first was worried if I was going to qualify since my vacation I gained more weight and now my BMI is 41.5 and I feel miserable. I can't wait to start losing but I don't want to until my first appointment. See here I had to go to the seminar and my first appointment I see all of the people I need like the nut. pshy. and etc. They tell me I will be there for four hours. I know every state is different but when it comes to Medicare and Medicaid I believe that since they are a government they are the same in every state. If not I live in Mass. and I know what I told you is right for Mass. But to be on the safe side call maybe you will get more information from them then I could get. Good Luck to you and hope everything goes well for you.

CWSBBYMUTHAOF3
on 5/5/14 11:17 pm

Thank you for your answer and I hope all goes well with your surgery! 

christyhall
on 5/6/14 1:55 am
RNY on 04/28/14

Louisiana Medicaid has its provider manual online. It is from 2012 and could be outdated. It does not answer your specific question about what happens if pre-op weight loss puts you under the 40 BMI. The basic policy does not say anything about requiring a certain amount of weight loss or a certain length of time losing weight, however this does not necessarily mean they don't require these things. http://www.lamedicaid.com/provweb1/Providermanuals/manuals/P S/PS.pdf (open and then search for weight loss surgery).

The best way for you to find this information is to either try to contact Medicaid (look on your card for a number) or to contact the surgeon's office where you had the weight loss seminar. Assuming your surgeon is in Louisiana, no doubt he or she has dealt with getting Louisiana Medicaid approval for surgery many many times. They might have an insurance specialist in the office who would know the answer to your question.

RNY on April 28, 2014 with Laura July at Unity Hospital in Fridley (Twin Cities) Minnesota.

Starting weight in October 2013: 350 lbs. SW: 275 lbs. CW: 242 lbs.

   

CWSBBYMUTHAOF3
on 5/6/14 9:00 am

Thank you! I contacted Medicaid and they told me that they don't have a specific amount of waiting before surgery. When I asked the staff they weren't really helpful because they couldn't tell me answers the way I needed them lol. The nutritionist only said to come in with a "perfect diet" and that should shorten the amount of visits needed, but couldn't answer anything else. Hopefully I will find out more this Thursday for my consultation! 

×