Illinois Plans Under Medicaid Covering WLS

[bb1008 1]

Hi there,

I haven't really posted here before because I kinda gave up on the possibility of ever getting WLS because none of my employers' insurance covered it. I was recently accepted on Medicaid and I'm looking for some insight on which plans under Medicaid, particularly in Illinois, (as I gather there are different health plans under the Medicaid umbrella) cover weight loss surgery and how difficult it can be to obtain it.

According to the acceptance letter I'm offered three plans: Illinicare Health, Meridian Health Plan, and Illinois Partnership for Health. I called each of the plans today and according to what I was told over the phone Illinicare and Illinois Partnership for Health do not cover weight loss surgery. Or at least Illinois Partnership for Health said they do not cover it but when pressed if proved medically necessary and recommended by a physician, I was told the doctor would submit the documentation to the state and it would be up to the state whether it was approved--there was no guarantee.

Meridian Health Plan said it was covered but with the following stipulations:

• Must be over a 40 BMI
• Must complete 6 months of weight loss treatment (Weight Watchers is covered by the plan but I can choose a different one if I prefer. Also 2 nutritionist visits are covered per year)
• Must lose 10% of body fat (or weight, can't remember which now) within that weight loss program

Once completed, I would have to work with a bariatric center of excellence for 6 months and go through the process with them. When I asked which center I would use she said she couldn't tell me because they are still working out contracts with some centers. I also got the feeling that perhaps it would be a case of using a bariatric center of excellence of their choosing. I asked because one weight loss clinic my doctor recommended was over 2 hours away and had a wait period of a year for an appointment. I tried to keep my appointment but the day before traveling there was an awful winter storm and I got into an accident on the highway on the way there. That is just one of the obstacles I've had in any attempts I've had to lose weight and I'm sure everyone here has their share too.

My question for the forum is if anyone can tell me if they have had experiences with Illinois Medicaid whether with these health care plans or in general. I'm concerned if I was required to use a bariatric center of excellence of their choosing if the cards would be stacked against me. I'm worried the requirements will be so stringent that a person couldn't meet them at all. There are all sorts of stories floating around about how insurance companies can make it near impossible for the insured to get the healthcare and services they legitimately need with endless hoops and red tape that ultimately results in the person going without. I'm more than fine with doing the work, filling out forms, eating and being active as the doctor requires and anything else but to be perfectly honest I'm all out of hope. I will put in all the work necessary to finally be free of this but I want to know it's going towards accomplishing my goal. I don't know how many more failed starts I can take. I'm sure people here can relate.

If you're still with me after that long post I appreciate it. I also I know Medicaid is a sore subject for some people and I'm possibly opening myself up for written lashings and judgement but I'm not sure where else to ask. I would appreciate all information and help.

Thank you in advance.

[amponder 396]

I am not from Illinois but i have medicaid in KY, and the 1st 2 stipulations you list are the same in KY the 3rd is slightly different it's only 5% of body weight here. I had no trouble getting approved. I hope it goes just as well for you and someone can come along and answer this.

[ddub67 0]

Hello bb108. Just wondering how things worked out for you with Meridian insurance. I have Meridian now and just beginning the process?

[Dana Collins 0]

Hi bb1008, just reading your question. I recently just switch my Medicaid health plan to meridian after researching coverage as well. However, I'm a 11yr. Vet of the gastric bypass, I'm presently seeking a revision to possibly the ds switch. At that time 11yrs ago I had bcbs ppo, I was still denied several times and I did more than my share of stipulations until they finally got an approval. I've been practically asking the same question of coverage (rearranging the words) till finally I run into a statement that says meridian is covered once in a lifetime with exceptions of fixing complications, but does not cover members with prior bariatric surgeries. I've been having the 8-10th year complication/ failure issues that I'm seeking help for, my situation makes me a prime candidate for revision. Hoping that my team can get what I need done to qualify. Because once your surgery is done no one wants to touch you cuz they don't know the (gps) of your abdomen, smh. Let me know how the meridian experience turned out for you, my pre opt consult for revision is Friday🤔😣😒😞🤞🤞🤞🤞👍

[ddub67 0]

Hello, sorry to hear that it's not working for you. I just switched to Meridian because I don' have insurance coverage at my job. So I'm just starting the process. I' considering the GS. I have to complete the 6 month supervised diet and all the testing, then I guess they will submit it to Meridian for approval. Im lost and do not quit understand everything, and afraid the clinic won' t consider me as a good candidate because I have a lot of medical issues. Praying!

[kakatlady612 1,053]

Praying your medical issues can be used for co morbidities. What do you have? Maybe there is still a way to work your way through the Insurance Jungle.

Sent from my VS880PP using BariatricPal mobile app

[N.Lyshay 13]

I have Medicaid. BCBS family plan. Medicaid covers the surgery so I’m not sure why they said that. I just had my last appointment waiting on Insurance approval now.

[TeePalmer 0]

I have Illinicare and I was also told over the phone they do not cover bariatric surgery...

[frust8 963]

Let me guess, Illinicare thinks obesity is an avoidable disease, you chose to have it. Ooh that's why people blow places,like that up, sheer frustration. Well Mr Bureaucrats, I have had it for years and it isn't fun. It is a slavemaster that is not easy to.escape. Refusing to cover bariatric surgery is a simplistic answer to a complex multi-faceted problem. But it is cheaper for them this way and,they worship their budget and bottom line[emoji19]

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[TeePalmer 0]

17 minutes ago, frust8 said:

Let me guess, Illinicare thinks obesity is an avoidable disease, you chose to have it. Ooh that's why people blow places,like that up, sheer frustration. Well Mr Bureaucrats, I have had it for years and it isn't fun. It is a slavemaster that is not easy to.escape. Refusing to cover bariatric surgery is a simplistic answer to a complex multi-faceted problem. But it is cheaper for them this way and,they worship their budget and bottom line

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It is just plain crazy and confusing...