anyone from Indiana get WLS using Medicaid? Is it hard to get approved through Medicaid?

[cherrybomb420 1]

has anyone use Indiana Medicaid? And is it hard to get approved through Medicaid?

[jtickle 295]

You should call to find out what your state requires. Every state is different, I'm from Arkansas and Medicaid pays 100% of weight loss surgery here.

[cherrybomb420 1]

thanks so much I will do that

[cherrybomb420 1]

was it hard to get approved in your state? I'm so worried I wont get approved,

[jtickle 295]

I have UHC insurance through my husband's work. My husband and I went to a seminar for my husband, so he can start the program. The insurance coordinator was there and she explained that Arkansas pays 100% if you have Medicaid, but Medicare only pays 80%. Good luck with your WLS journey and keep us posted.

[cherrybomb420 1]

so I called my provider and asked about guidelines and coverage and she told me Medicaid would cover WLS 100%.then I asked what the guidelines are to get approved ? and she said what do you mean guidelines? I don't understand and continued saying ma'am as long as your PCP sends a referral saying its a medical necessity then we should have no problem .I couldn't believe what she was saying because it sounded to good to be true(to easy). I said so there's nothing I need to do to help me get approved ? things like 6mth of weight loss documented by my PCP and BMI level etc. she kept saying as long as my PCP sends a referral saying its a medical necessity that should be all you need. for some reason I still don't believe it and I'm calling back tomorrow . So my question is has anyone been approved with just a referral from PCP?

[Shauna29 47]

so I called my provider and asked about guidelines and coverage and she told me Medicaid would cover WLS 100%.then I asked what the guidelines are to get approved ? and she said what do you mean guidelines? I don't understand and continued saying ma'am as long as your PCP sends a referral saying its a medical necessity then we should have no problem .I couldn't believe what she was saying because it sounded to good to be true(to easy). I said so there's nothing I need to do to help me get approved ? things like 6mth of weight loss documented by my PCP and BMI level etc. she kept saying as long as my PCP sends a referral saying its a medical necessity that should be all you need. for some reason I still don't believe it and I'm calling back tomorrow . So my question is has anyone been approved with just a referral from PCP?

I know In Fl with Medicaid you have to do 6 months Documented weigh-Ins with your Pcp. An whatever else the surgeon tells you. Like Psych eval, see the Nut, EGD, Pulmonary clearance,Cardiologist clearance and mabey a sleep study. To be honest I think Medicaid requirements are the same In every state but don't quote me on that hope this helps

Edited May 4, 2014 by Shauna29

[latido 178]

In New York, Medicaid will ask you to have six weigh-ins and six nut visits, and a 'medical necessity' evaluation from the surgeon. They tell you that you must have a BMI of 40+, and two disabling conditions. They make it sound complicated, but when it really gets down to it, you will see yourself through it.