Roadblocks With Indiana Medicaid

[Ciara_Reese2 7]

My Husband and I were both interested in the vsg for our weightloss His BMI is 58, mine is 56, He was laid off of work and we are on Medicaid. At our first consultation we were informed that medicaid in our state does not cover the vsg, yet when I called them I was told that it was covered if it was medically necessary.

My only options are Bypass or Band.

So, next I thought maybe we could afford to add coverage and pay a premiums. So I checked out bcbs the sales agent said we would be denied until after we had the surgery if it was recommended by I doctor. Well my primary Care physician did write us a refferal.... so did I just blow it?

What are my options ?

Can Medicaid pay for us ?

Can we still get another insurance with medicaid to pay?

Can someone recommend one that has a decent premiums and not asking a huge deductible?

Mexico is not an option any other suggestions please! I am so desperate!

Ciara Reese

[keya34 46]

I dont know but would think if ur doctor wrote a letter saying it was necessary i would think they should cover it. Good luck to both of you.

[Mz.Smurf 31]

You can't have medicaid and bcbs...they will take your medicaid away....you are going to have to jump through hoops to get your surgery through medicaid...believe me im almost at the end of it all lord say the same...did your doctor diagnose you with anything other than being overweight because you have to have a medical reason...

[Patienlywtng on my Curves 73]

I used to work for the State. You are able to have additional insurance, but that insurance will be Primary and whatever is not covered Medicaid will pick up...so it would become your Secondary Insurance.

Honestly, you kind of lost me right at the part about speaking with someone from BCBS. Can you clarify?

1) Ok...your options. If not approved for VSG...there is still RNY and Lap Band, correct? They all will net the same results. When I initially looked into surgery, I looked at Lap Band, but I'm older now. I figured that would not do for me anymore.

2) Speak with your doctor's office again. Ask if in their practice if there were others who were approved using medicaid. They would only be able to give a yes or no answer, I'm sure due to HIPPA Laws.

Don't make a decision out of desperation. You will find the answers you need. Much success to you and your husband.

[Ciara_Reese2 7]

I used to work for the State. You are able to have additional insurance, but that insurance will be Primary and whatever is not covered Medicaid will pick up...so it would become your Secondary Insurance.

Honestly, you kind of lost me right at the part about speaking with someone from BCBS. Can you clarify?

1) Ok...your options. If not approved for VSG...there is still RNY and Lap Band, correct? They all will net the same results. When I initially looked into surgery, I looked at Lap Band, but I'm older now. I figured that would not do for me anymore.

2) Speak with your doctor's office again. Ask if in their practice if there were others who were approved using medicaid. They would only be able to give a yes or no answer, I'm sure due to HIPPA Laws.

Don't make a decision out of desperation. You will find the answers you need. Much success to you and your husband.

Well to clarify bcbs 's agent was helping me find an appropriate plan online and I mentioned weight loss surgery ( thinking that there might be a plan that would be have lower deductible) and they said that i would be denied if a doctor has already recommended surgery until after I have it,

I hope that clarifies thank you for the information. it seems my next step will be discussing this dilema with the ReStart clinic

regards,

Ciara

[Ciara_Reese2 7]

You can't have medicaid and bcbs...they will take your medicaid away....you are going to have to jump through hoops to get your surgery through medicaid...believe me im almost at the end of it all lord say the same...did your doctor diagnose you with anything other than being overweight because you have to have a medical reason...

My knee doctor said my joint pain was from being over weghit last year had Bursitis and Arthritis i could not walk without can. I needed Fluid drained in my knees. Do you have Indiana medicaid? who is your surgeon?

[Mz.Smurf 31]

My knee doctor said my joint pain was from being over weghit last year had Bursitis and Arthritis i could not walk without can. I needed Fluid drained in my knees. Do you have Indiana medicaid? who is your surgeon?

No I live in Dallas Tx...I was told by medicaid that u can't have 2 insurance co. My doctor is Dr.Jay

[bittahoney 12]

Bcbs is probably looking at the obesity and the surgery as a "pre-existing condition". Most insurances do not cover a pre-existing condition for a least a year.

[Patienlywtng on my Curves 73]

Ciara, yes thank you. I do agree with Bittahoney, it probably would now be considered Pre-existing.

Did you speak with someone in Hoosier Healthwise or EDS? EDS would be able to tell you exactly what Medicaid covers.

[GulfportMS 0]

My insurance with my job I have 6k out of pocket and 2500 dad (this isn't included in out of pocket). I was previously on hip 2.0 last year before getting converted to fill time perminent employee. My question is if I applied for hip 2.0 and keep my insurance with my employer does Medicaid have to approve the surgery as well or just my primary? Does Medicaid take in consideration mortgage, utilities, and premiums? My premiums are 120 every 2weeks. Also, if i wanted to keep my insurance and later try to apply for Medicaid after starting the 6 month process would out be Not covered because of waiting until month or two Before surgery?Any answers would be appreciated.

Edited January 10, 2018 by GulfportMS
Mis-spelled

[kakatlady612 1,053]

Ciara any updates? Decency would dictate you,both deserve WLS, but then you are dealing with State government and they aren't always known for decency, are they? Wish there was some way,to do them as a hardship case. In the long run you're both going be healthier and save them money, but ah how do you convince them of that? I hope somehow you get all straightened out.

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