Horizon Nj Health (medicaid)

[Jennalee058 0]

Hi all! I am a 24 year old female I am 5 foot 6 inches tall 235 lbs with no co morbidities my bmi is 37.9 and my first appointment to meet with the Gastric sleeve doctor (Dr.Attia) is May 20th... Can someone please tell me there is a possibility that I can have this surgery, or am I wasting my time?! also would I be eligible for something else worst case scenario such as the lap band?? How was the first appointment and how long does it take to find out whether you are approved? Sorry for all the questions !

[jessr0se 1]

Hello! I am not from NJ, but I am on medicaid. I know different states have different requirements for Weight loss surgery if you're on medicaid, but I'll let you know what I have found out about north Dakota's medicaid requirements. I believe, but dont quote me on it, that the requirements are the same for all Weight loss surgeries.

You must be over 18, have a BMI of 40 or over OR have a BMI of over 35 with at least one co-morbidity, complete a 90 day documented diet (some require 4-6months), have weigh-in meetings 4 times over that 90 days with a nutritionist, and complete a series of other appointments. Those appointments included: Information session with bariatric coordinator, meeting with the nutritionist about pre-op and post-op diet, meet the surgeon, have a consult with bariatric coordinator and finally have a psych evaluation. ND likes to schedule most of them all on the same day.

After going through all that, the bariatric coordinator still has some doubts I'll get approved because ND's medicaid makes it tough to get approved. I have high blood pressure and high cholestoral, but ND requires the co-morbidities to be "out of control", as in medication is not helping. I'm having a sleep study done in order to determine if I have sleep apnea, because that might help my chances. She said they most likely will deny the first time she submits everything, and then we can appeal. With the appeal, you can get a letter from your primary care provider stating why it is medically necessary to have this surgery, and you can also include a letter you wrote yourself stating why you believe it's necessary. It's tough but Im hoping and wishing and crossing my fingers that I'll get approved.

I started this journey in January and would have liked to have the surgery by june. I'm hoping to hear from medicaid by the end of May. It seems like a long process but it has gone by fast and it's given me lots of time to research the gastric sleeve.

[Sleeve Me Please 1]

Hi. I also have medicaid and united healthcare. I am seeing Dr.Ward in Morristown. The best thing for you to do is call your insurance and ask what there requirements are. Each insurance is different. Good luck!