Medicaid and Medicare approval

[Lisa1171 2]

Hello i just want to know if anyone has medicade and medicare and if they cover the gastric sleeve surgery.I just satrted the process to surgery date i have my first orintation the 18th of nov.Can someone tell me how long the whole process last from the start to the finish my mom said it took her 3 yrs that's a really long time thanks lisa

[EvieLamp 11]

I'm early in the process, and Medicaid will be my coverage for surgery. I've seen quite a few people mention using Medicaid and Medicare as their insurance and were approved for surgery. Do a search for Medicaid or Medicare on the top right corner of the page.

http://www.bariatricpal.com/index.php?app=core&module=search&do=search&fromMainBar=1

[ThinnerMe2015 14]

I'm not sure which one pay for what but it shouldn't take 3 yrs for the whole process, I wish you luck. I have Medicare/Medicaid as well.

[ruth1966 31]

Hello i just want to know if anyone has medicade and medicare and if they cover the gastric sleeve surgery.I just satrted the process to surgery date i have my first orintation the 18th of nov.Can someone tell me how long the whole process last from the start to the finish my mom said it took her 3 yrs that's a really long time thanks lisa

I started back in April 2014 and am just submitting paperwork today to medicaid so we will see what they say. I am hoping so I can get some weight off and get back to work. I miss working believe that or not. It's hard to keep a job when you can't stand very long because of bad knees and weight.

[DoggieMama 20]

I, too, went though the process with Medicare and Medicaid. First off, find out their requirements. You can call the number on your card or look online. Medicare does NOT do a prior authorization but Medicaid does. Medicare will be your primary. I was denied by Medicaid and told by the hospital that if Medicaid denied then it was very unlikely that Medicare would pay.

However, because I felt confident that I did meet the requirements, I sent a letter to Medicaid requesting an appeal hearing. Within a week I got a letter with an appeals date, then 2 days after that I got another letter saying that Medicaid had decided they cover my surgery after all. Makes you wonder if they just automatically deny and hope you don't appeal. Anyway, my point is- do your homework and don't take "no" for an answer.

[Lisa1171 2]

i called midicare they said you have to have body mass over 35 witch i do and have illness that cause u to need the surgery im just starting the process woundering if i should continue i have acid reflex and high cholesteral and body pain's medicaer said i need a number for them to give out info

[DoggieMama 20]

Medicare requirements are very similar to Medicaid. Make sure that you have seen your Dr and have actual medical diagnoses in your medical records. Make sure the acid reflux is in there as GERD, make sure if your body pains are in the joints that your Dr has done x-rays and that there is a diagnosis of degenerative joint disease, etc. Just saying you have heartburn or body pain will not be enough. You need documentation in your medical records of ALL of your co-morbidities.

[Lisa1171 2]

thank's for the info

[DoggieMama 20]

By the way, from start to surgery for me was about 7 months. And that included the couple of weeks of the whole appeal crap.

[flmommyof2 79]

I am still waiting on my exact date but do know its the middle of December and I am having Lapband but i had my choice between that and the sleeve. Medicare is my primary/medicaid secondary. My first visit to my doc was Sept. 16th. I have finished all other required task asked of me besides that I will see my Nutritionist Thursday and i will get my exact surgery date then. Getting REALLY excited!

[Lisa1171 2]

I have acid reflex but not sure if it's charted as gerd or not and i have aches an pain in my feet but dont know if i should go to the dr again seems like im always there.

[flmommyof2 79]

Not sure if you need to know how to get approved but With Medicare, with Florida at least, for what i know about approval, you have to have had been overweight for at least 3 yrs, have either high bp, sleep apnea, diabetes. And there are a few more things that qualify and your bmi has to be more than 40 or at least 35 w/co-morbilities. If you haven't been diagnosed with sleep apnea, they may send you to get tested. I myself do not have high bp or diabetes but I do have sleep apnea which I found out after my Doc sent me for the test. I also have acid reflux..BAD. Lapband from what I have been told, will help that if not cure it. I have bad joint pains and arthritis. Looking forward to being lighter on my feet..literally:) Good luck hun!

Edited November 17, 2014 by flmommyof2

[Lisa1171 2]

thanks for the info i think i hope they do a sleep study on me .I have a bone mas over 35 i have high chestrol and acid reflex i have my first orintation tomorrow it's going to be a long process

[flmommyof2 79]

They should do a study if you have never had one. If you DO have signs of s.a. make sure to let them know that. I felt like mine was gonna take forever...but it's flying by. I'm a little ahead of you in the process so maybe if you have any questions I can answer them for you. Hit me up anytime and add me as a friend if you want.

[ruth1966 31]

well it's been a week today since paperwork was submitted to medicaid and haven't heard anything yet. I have been doing this since May and am so ready to get this over with so I can start living a more full life. I miss working and doing things with the grandkids. I just wish they would hurry and and make up their minds whether to approve me or not.