How easily is it to get approved with Badgercare for the gastric bypass surgery?

raeshell
on 2/27/19 5:47 pm

I recently saw the Weight loss surgeon and he said I was a good candidate for weight BMI is 41. The doctor told me I should go through all the steps. I should see the dietician once a month for six months and all the other steps. The doctor also said that my insurance might not cover my surgery because I don't have any other medical problems. Has anyone else been told this and if they have what was the outcome?

ladygodiva1228
on 2/28/19 4:36 am - Putnam, CT
Revision on 02/04/15

Have you personally called your insurance company and asked them if they cover WLS and if they do what are their requirements?

I have seen folks go through everything because their surgeons office said the insurance would cover it only to find out that there was an exclusion and WLS was not covered. Then I've seen folks who's surgeons said their insurance wouldn't cover WLS when in fact they do. Never rely on the surgeons office to say if insurance will or will not cover WLS.

With a BMI of 41 you would be a candidate for WLS even without other medical conditions.

I advise you to call your insurance and talk to them.

Dr. Sanchez Lapband 9/12/2003
hw305/revision w280/cw197/gw150

Revision from Lap Band to Bypass on 2/4/2015 by Dr. Pohl

    

Librarian67
on 2/28/19 5:25 am
RNY on 02/28/17

I agree. While your surgeon's office may have experience with your insurance company, each policy is written differently and the ONLY source of real information is your insurance company. Do remember though that saying they will or won't cover the surgery now, doesn't mean that they won't change their mind or reconsider unless there is an exception in your policy.

HW: 248+, SW (RNY: 2/28/17): 244, GW (10/17): 125; LW: 115; 45# regain (19-20); CW: 135.6; new goal: 135; Plastics: Ext mastopexy, Ext abdominoplasty-5/18/2018; diagnosed w/ gastroparesis 11/20.

catwoman7
on 2/28/19 5:32 am
RNY on 06/03/15

BadgerCare is Wisconsin's Medicaid program. I just googled it and it does say it covers bariatric surgery with prior authorization, but I agree you should check with them before you get too far into the program. It could be there have been changes (the documentation I'm looking at is from 2011).

RNY 06/03/15 by Michael Garren (Madison, WI)

HW: 373 SW: 316 GW: 150 LW: 138 CW: 163

dreamer1234
on 2/28/19 12:41 pm

i do recommend that you call your insurance first. i called my insurance first before i even started the process. there is a book on amazon about what to do when your insurance turns you down for weight loss surgery.

raeshell
on 3/1/19 11:29 am

Thank you everyone!!

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