Will Medica Pay For My Surgery Help Advice Pleasee.. ):

[YumiiShyy 0]

Ok so i am over weight majorly actually clinically obese:/ And i want to get the lap band surgery. When i turned 18 last march i looked into it deeply, In order for my medica to pay for it i had to go on a 6 month supervised diet etc so i did now i go for my appointment for a EGD this Wednesday. So basically im out of the woods and i know the surgeon will do the surgery. BUT i still don't know if my medica will pay for it, i wont know until i do all the tests i have to do first. I read they will accept if it will help my medical problems etc. I also read that if you have sleep apnea they will accept because of that. Well heres a list of medical problems i have and meds that i take for them i hope may help me get accepted? Asthma everyday it affects me (had it ALL my life on 3 meds for that), abnormal thyroids (on med for that 50m), Just got put on meds for my hemoglo, i have high blood pressure and just got put back on meds again for that , i have sleep apnea i have a machine to sleep with, i have depression i take meds for that, i have meds for bad Migraines, and i think that's all that i can think of at lol. Also i used to cut.. And i go to a consler every week. My bmi is beyond outrages. Its 52.5 I really hope they do because my papa has paid in total 180 for my 6 visits. And that will be a waste of money and i will feel horrible if its a waste. We knew we were taking a chance from the begining. I also feel like this is my only hope.. My medical problems keep getting worse i cant breath, everything i do effects me. I have tried everything.. I just hope my chances are high for them accepting me.. What do you think???? Im just soooo worried..

[PWoo10 7]

Your doctors office should have someone who works with the insurance and can tell you the requirements and if it is even covered.

[Jerseygirl82 18]

With your current BMI and list of health problems I would think you are a good candidate for the surgery but call and talk to someone at your surgeons office. Since they deal with insurances all of the time they would hopefully have some good advice for you.

Also, your post said you cut. I am assuming you mean the form of self abuse? I am ashamed to say this but I too am a cutter. I think that the same thing that makes us feel emotional pain and need to cut ourselves to heal it is the same as the need to eat to bury that pain. I think the two go hand in hand. Good luck with your journey. I am here if you would like to talk more.

[xavier 153]

With your BMI and the apnea and high blood pressure they should pay...these are pretty standard criteria...your doc's office will know for sure! Good luck1

[YumiiShyy 0]

With your current BMI and list of health problems I would think you are a good candidate for the surgery but call and talk to someone at your surgeons office. Since they deal with insurances all of the time they would hopefully have some good advice for you.

Also, your post said you cut. I am assuming you mean the form of self abuse? I am ashamed to say this but I too am a cutter. I think that the same thing that makes us feel emotional pain and need to cut ourselves to heal it is the same as the need to eat to bury that pain. I think the two go hand in hand. Good luck with your journey. I am here if you would like to talk more.

Yes self abuse. I talked to the lady who called today about my appointment and asked her and she said they will not know if my medica will pay until i do all these other tests sadly:/ Its really nice to know im not the only who does cut you are the first person i have met besides 2 other people who just tried it once lol. I thought me being a cutter was going to effect my chances, because like a week ago my surgeon was saying he was worried about doing the surgery because of that:/ But luckily he is comfortable now. I have been cutting since i was 12 so its my one and only addiction that i struggle with. But just out of curiosity have you gotten lapband or gastric bypass surgery?

[Jerseygirl82 18]

I will be having the lap band done. Hopefully in March. I have all my pre reqs done I just need to go to my surgeon next week to finalize everything. I haven't cut in over two months. That's my longest in a long time. I have had many moments I wanted to but I am really trying to re-start my life.

[YumiiShyy 0]

I will be having the lap band done. Hopefully in March. I have all my pre reqs done I just need to go to my surgeon next week to finalize everything. I haven't cut in over two months. That's my longest in a long time. I have had many moments I wanted to but I am really trying to re-start my life.

Last time i did it was in december:/ On my nieces birthday for that matter. But before that the last time i did it was in june. Ah your soo lucky i feel like i will never get a date thats why im hoping my medica pays.. But so far im just trying to stay positive and just pray. Im happy that your trying to change though(: I mean i am to and i KNOW it can be soo hard. Did you have to get a EGD?

[mahogany1177 0]

Hello,

I would start by looking at your insurance company's policy book which is usually available online and look under covered services. Your approval is based on proving medical necessity. Generally, with most insurance companies what they are looking for is a BMI 35 or higher, co-morbidities ie, hypertension, diabetes vascular disease, heart conditions, as well as health-related issues associated with obesity that thwarts your quality of living. Also you are required to generally have a psychological evaluation, a sleep study proving the sleep apnea which by the way can be viewed as a co-morbity as well when it is severe,but keep in mind if your sleep apnea is very bad you may have to be treated for that first to prove you will be fine to go under anesthesia. You are usually required to see a nutritionist, go on a medically surpervised diet and the time frame for that varies by insurance. Some insurance companies require you to quit smoking prior to surgery if that applies to you. Based on my experience with South Dakota Medicaid, you sound like a candidate to get approved. Just know this, you are likely to be denied the first time you submit and not because you are not a candidate either.Find out the basis for denial and re-submit. Do Not Be Discouraged! File an appeal immediately if this happens. When you have all the supporting documentation and have completed all of their requirements you should be persistent to get this life-changing procedure. It is your right to have a chance to live life abundantly and happily. I also had each of my doctors ie psychologist, neurologist, primary care physcian, write a letter of reccomendation and I submitted a handwritten letter describing my personal quality of life and the need for the surgery. But all of this will be in vain if your insurance company excludes bariatric surgery from its coverage ie Arizona AHCCCS ( AZ Medicaid as of October 1, 2011).

I will be glad when our government will take obesity more serious and recognize it as a disease that needs to be treated and prevented.

Good Luck & Best of Wishes

Mahogany1177

[Sweetjess602 12]

FYI. AHCCCS in Arizona does cover bariatric surgery for medical necessity, depending on which insurance. I have Care1st and they cover it.