Anyone get sleeved with Medi-Cal?

[mrjoeym 0]

I'm going to the seminar on Tuesday and am excited to get the process started. My regular doctor told me he had a patient that was approved from medi-cal no problem. I was wondering if anyone had experience with medi-cal insurance for the sleeve? Did they require 6 month supervised diet, co-pay, etc? Any help appreciated, I'm so anxious to move ahead with this lol

[Sharon1964 2,530]

The Medi-Cal Provider Manual has this to say about gastric surgery:

Approval of a Treatment Authorization Request (TAR) for

1. is required and must include

all of the following documentation:

◾The recipient has a BMI, the ratio of weight (in kilograms) to the square of height (in meters), of:
◾Greater than 40, or
◾Greater than 35 if substantial co-morbidity exists, such as life-threatening cardiovascular or pulmonary disease, sleep apnea, uncontrolled diabetes mellitus, or severe neurological or musculoskeletal problems likely to be alleviated by the surgery.

◾The recipient has failed to sustain weight loss on conservative regimens. Examples of appropriate documentation of failure of conservative regimens include but are not limited to:
◾Severe obesity has persisted for at least five years despite a structured physician-supervised weight-loss program with or without an exercise program for a minimum of six months.
◾Serial-charted documentation that a two-year managed weight-loss program including dietary control has been ineffective in achieving a medically significant weight loss.

◾The recipient has a clear and realistic understanding of available alternatives and how his or her life will be changed after surgery, including the possibility of morbidity and even mortality, and a credible commitment to make the life changes necessary to maintain the body size and health achieved.

◾The recipient has received a pre-operative medical consultation and is an acceptable surgical candidate.

◾The recipient has an absence of contraindications to the surgery, including a major life-threatening disease not susceptible to alleviation by the surgery, alcohol or substance abuse problem in the last six months, severe psychiatric impairment and a demonstrated lack of compliance and motivation.

◾The recipient has a treatment plan, which includes:

Pre-and post-operative dietary evaluations and nutritional counseling, counseling regarding exercise, psychological issues, and the availability of supportive resources when needed

◾Authorization for bariatric surgery will only be approved for a Centers for Medicare & Medicaid Services certified Center of Excellence (as designated by the American Society for Bariatric Surgery or certified Level I Bariatric Surgery Center by the American College of Surgeons).

[CaPoppy 22]

I am getting a sleeve with Medi-Cal. I had to switch to the Anthem Blue Cross version of it. The only requirements are a psych appointment and a nutrition appointment. There is no diet requirements. You just have to have the BMI that meets their criteria as a pp outlined.

The process has been super easy. I had my initial appointment Jan. 7 and did my required Psych and nutrition appointments quickly. They submitted and received approval quickly and everything has went great.

I have had no oop costs. Everything has been covered. My Dr. has a program fee, so that is not covered. So that will be my only cost.

[latido 178]

I just moved to the Bay Area and am looking for a group to follow-up with since my RNY in New York. I have Medi-cal + Anthem. Where did you guys go to?