Medicaid and Surgery

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The Truth About Medicaid And Weight Loss Surgery

There are many myths about Medicaid and Medicare when it comes to weight loss surgery. For more than 10 years I put off surgery because I had Medicaid and then Kaiser. When asking the insurance company if weight loss surgery is covered, they will always tell you no. The best place to start is reviewing your 'what's covered' excerpt in your manual. Many health insurance companies will cover your surgery as long as it is medically necessary. A medical necessity is these three things: 1) BMI over 40 2) Two Morbidity (i.e. diabetes, high blood pressure, sleep apnea, heart condition, etc.) 3) Pre-op weight loss. These are the guidelines for most insurance companies, but I really wanted to discuss Medicaid/Medicare. Medicaid in most states will cover your surgery as long as you meet their guidelines for medical necessity. The first place to start is with your PCP. If you make your PCP aware that you are considering weight loss surgery, they will be able to refer to you to a surgeon that accepts your insurance. The surgeons are familiar with the procedure and will get the surgery approved as long as you qualify. Depending on your state, Medicaid will allow certain procedures. In Ohio the Gastric Sleeve is not accepted for the weight loss surgery, but Lapband and Bypass are. This is the step that you stay in constant contact with your surgeon and they will have a specialist that handles all insurance questions that knows these companies in and out. The surgery will not happen quickly, the normal wait time for Medicaid/Medicare is nine (9) months. You report to your surgeons office once per month for weigh ins and follow-up with dietitian and the surgeon. There are also several tests are required. I would suggest doing them as soon as possible, this way if there are any additional tests that need to be conducted, you have time to get them done. Because most states have opted to provide their Medicaid/Medicare in *** form, it actually works a lot better than if it were strictly run by the State. My insurance is Molina of Ohio (Ohio Medicaid), I was approved for surgery after the 1st request. My surgery was paid for 100% without complication. The nine month waiting period gives you time to make sure that this is the right choice for you , and also begin changing you lifestyle. So if someone tells you that weight loss surgery is out of the question because you receive Medicaid/Medicare, this is not at all true. Check your manual and with your PCP, if you have any questions I may be able to assist. I hope that this blog helps people understand that there is hope for those that struggle with their weight and receive public health benefits.

Lady S.

January 30, 2012

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