The Dr. Supervised Diet & Questions about Illinois Medicaid

[Beck90 189]

Hi there

I'm 24 years old and looking into getting a gastric sleeve in order to help me successfully lose weight. I've struggled with my weight since I was young and have never successfully been able to lose more than a few pounds even when trying very hard. I'm hoping this tool will help me!

However, being able to do this absolutely depends on my ability to get Medicaid to cover it -- elsewise it's too expensive. And I'm nervous about at least one aspect of Illinois' Medicaid requirements for them to cover me. They say you have to have been part of a doctor supervised weight loss program for six months. This is the part I have questions about.

My doctor asked me about a year ago if I was doing anything to keep my weight in check and I told him I was walking and working on an elliptical. He was pleased and documented it my chart and told me to keep it up. I will also say that my Doc has mentioned that he's not always pleased with the restrictions insurance companies impose to basically save themselves money but that often keep patients from getting what they need. ((We went there because I have a super serious anxiety disorder / possible Bipolar II and he couldn't prescribe me what he wanted because Medicaid wouldn't cover it and he was annoyed as he couldn't give me the medicine he thought would help the most. -- and yes! I'm working with a psychiatrist also and in therapy )) Do you all think it's possible that he would consider this a Dr. supervised weight loss program then and indicate to medicaid that I have indeed been part of said program for six months? Or do you think it's more likely he'll want to write up something more formal for me to follow?

Which leads to my next concern. If he does want to have me follow a more formal diet for six months.. I'm super concerned about not losing my medicaid. (which would mean no surgery.) Here's the situation. I believe in Illinois for a single person you can't make over 15,000 dollars a year (or close to that) and keep free Medicaid. I currently have an application in to become a 911 operator and it looks promising that I might be hired in mid-September. At this particular facility during the training period they have you work full time hours during the day. Training time is not dated. They will have you train as long as they feel you need it. My friend that worked there said she'd seen everything from 6 weeks to 6 months for various employees. After my training I would go back to part time. Now working there part time I won't have a problem keeping my Medicaid.. but the full time hours when I calculated what I would make might put me over the limit. I'm very concerned about this... I don't want to lose either an awesome job opportunity OR the chance to have this tool that could help me change my life forever.. yet I feel like I might have to choose... I don't want to say pass on the job to ensure I keep my Medicaid for surgery because I absolutely want to work in THIS position in THIS 911 office (I have close friends there who've been trying to get me hired for the next open position for 6 months). But I don't want to take the job and lose my Medicaid and lose my dreams of finally having a tool that can help me..

So in summary... Do you think my physician noting down what exercise I've been doing and approving me to continue could count as a physician approved weight loss plan? And .. if not.. do you have any words of wisdom about how I can go about not losing either of these things that matter to me?

Note: Please don't say I may have to choose or etc. I know this is possible.. and I'm already at near panic attack level over it. I'm looking for positive reassurance Thankyou!

And if you took time to read this long long thing, you're wonderful!

[MIMISAN 404]

If they are like my insurance they will be looking for Dr. appt dates and Dr. notes on your weight each month as well as what your are working with the Dr. on regarding teaching you the proper way to eat.

Most Drs. are afraid of being sued to lie about those things, but you can ask him. They want an actual month to month record.

Edited August 6, 2015 by MIMISAN

[OutsideMatchInside 10,166]

Even if you lose medicaid, you can buy a health insurance plan on the exchange at a discount that will cover surgery (look at the BCBS plans). So talk to your doctor, take the job, and it will work out. Illinois also has expanded medicaid so that might offer more options. I don't know much about medicaid but I do know you can buy a plan on the exchange and it will cover WLS.

All the things you need post surgery add up. You are going to need a decent income to be able to take care of yourself after surgery.

[hayleyw4 0]

I don't know how it works for Medicaid but my insurance through Premera says the physician supervised diet has to be six consecutive months meaning I have to go in to my doctor once a month, get weighed, discuss diet and exercise, and talk about goals for the next month.

[Beck90 189]

Ahhh okay then! I wasn't sure of the specifics for the 6 month plan.. It sounds to me then like I might be starting my 6 months on Tuesday when I go into the doctor. I was dreading it but now I don't know.. I'm not pleased that it'll mean my surgery is for sure six months away but it is part of the process and maybe if I can keep thinking about it that way it won't be so bad. If I can arrange all my preop tests and appointments over those six months, it'll give me something to be doing while I'm waiting.

Thanks for the info on buying Medicaid plans on the exchange!! I had never heard of this! It makes me feel better. I also spoke to the woman at the health department who helped me apply and she said if my training income goes over I can likely write for an exception because it's only for a temporary time so that I don't lose my medicaid So that would be great! I'm pleased that it's starting to sound positive for this to work out!

What sorts of expenses do I need to look out for post surgery? I mean there's the obvious doctor visits but those will be covered. I'm not sure what else after beyond visits with the doctor and dietitian etc. And food.. but I already have to buy that anyway lol.

[OutsideMatchInside 10,166]

Vitamins can be expensive and you need the good ones. They are not regulated by the government so you have to spend more to get the good ones. The high quality Protein costs too. You are going to have to replace clothes as you lose, etc.

[Pinkgirl1234 761]

Beck 90,Whatever it takes do it..6 months can go by very fast .Get Medicaid to cover...I got NJ Medicaid.i don't have the finances for anything out of pocket.Not even Vitamins right now.

[Nurse_Lenora 903]

I'm in IL and just started my 6 month wait this month also. It seems like it will be forever but I know it will go quickly!

Have you found a surgeon and a program ?