GA Medicaid: Wellcare of GA

[mommychuchii_ 1]

Hi everyone! This is my first post. Currently I applied for GA Medicaid and got approved. I submitted my paperwork for Wellcare of GA and now I'm just waiting for card so I can go through and start whatever I need to do with the surgeons office. I would love to hear from someone who went through Wellcare of GA for the Sleeve surgery. I know I am just starting my but I don't know the processes and what Wellcare will require me to do so hearing from someones experience would be great!

I'm 21 with a BMI of 46.3

I appreciate any feedback, thank you in advance!

[allycatt98 35]

Hi everyone! This is my first post. Currently I applied for GA Medicaid and got approved. I submitted my paperwork for Wellcare of GA and now I'm just waiting for card so I can go through and start whatever I need to do with the surgeons office. I would love to hear from someone who went through Wellcare of GA for the Sleeve surgery. I know I am just starting my but I don't know the processes and what Wellcare will require me to do so hearing from someones experience would be great! <br><br> I'm 21 with a BMI of 46.3 <br><br> I appreciate any feedback, thank you in advance!

Hello,

I worked in the Utilization Review dept at WellCare for years. Their Clinical Coverage Guidelines are available online. Just click on the "Providers" link, then select Provider Resources. The process isn't difficult, but I would allot at least a week for review time. Their volume is really high.

In regards to process: The Nurse Reviewers will review the request for medical necessity based upon the guidelines. If everything has been submitted by your doc and criteria met, then the nurse can approve the request. Notification of the approval is faxed to the surgeon and hospital. If criteria is not met, the request is sent to the Medical Director for determination.

[Ep90 0]

I have Medicaid/Wellcare of Ga.Well my PCP just sent in an authorization so I can get my process started. I just wanted to know on a scale of 1-10 how likely am I to get approved if the only criteria met is my BMI is high... I'm 23yrs old,height 5'7,and my BMI is 51. I'm very anxious to know. And I live in South East Georgia and I have no idea what bariatric surgeons take my insurance. Any information would be helpful.

[allycatt98 35]

I have Medicaid/Wellcare of Ga.Well my PCP just sent in an authorization so I can get my process started. I just wanted to know on a scale of 1-10 how likely am I to get approved if the only criteria met is my BMI is high... I'm 23yrs old,height 5'7,and my BMI is 51. I'm very anxious to know. And I live in South East Georgia and I have no idea what bariatric surgeons take my insurance. Any information would be helpful.

I'm a bit unclear. Why would your PCP be initiating anything? From what you advised, you have not met any criteria and do not have a surgeon. Submission of an auth request just doesn't make sense.

You can find a surgeon by going to the WellCare of GA website. If you still have trouble finding a doc willing to accept you, then I would contact Member Services and get them working on your behalf.

I regards to the auth request, I don't believe it will be approved. You haven't met any of the criteria including the all important psych eval.