Medicaid In Arkansas

[Heagler 18]

I have my first appointment on December 22nd to get the process started for Gastric Bypass. My current health insurance is Arkansas Medicaid. Gastric bypass is covered with requirements. There is one thing I am not too certain about and in the requirements it's not very clear. Some people I have seen that have medicaid say that they have had a referral from their PCP. The billing specialist called me last week and said I needed a PCP attached to my Medicaid. I just got medicaid at the beginning of this month and had not yet done it. So, when she called I got a doctor set up as my PCP. I called the billing specialist back and told her I got a PCP attached to my Medicaid. I then asked her if I needed to go see my new PCP and she said "no." I mean, I will ask more at my 1st appointment but I was wondering if anyone had any idea if you need a referral for medicaid in all states?

[mssteal216 45]

I too am in Arkansas and have already started the medicaid process about 8 months ago. Im using Dr Gibbs. In order for medicaid to pay you will MOST DEFINITELY have to go see the PCP because medicaid requires 6 months of physician supervised dieting, he or she also has to write a letter of referral stating that the surgery would benefit you and that your obesity isn't genetic. You also have to have a psych evaluation done, labs completed and BMI has to be a certain number with co morbidities. These are all of Medicaids requirements in our state of Arkansas for coverage. Message me if you have any questions

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[Jazzzyjay 222]

I'm in Nebraska and I didn't need a referral. I just called the bariatric clinic and made my first appointment. I have Medicaid as well.

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[mssteal216 45]

I started the process on my own as well. All I had to do was attend a seminar for 3 hours to get everything started. What I'm saying is that in order for Medicaid to "pay" for the surgery a letter from your PCP along with everything else stated above is required. They will give you a checklist when you go to your appt or seminar letting you know what is needed.

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[Heagler 18]

I had a friend who has Medicaid and did the 6 months of required dieting through the weight loss center. I am going to the same doctor as her, we are in Fayetteville. I haven't asked her yet about the PCP because she just has a baby and I don't want to ask her questions since she's recovering from a C-section and bonding with her new baby. I never thought to ask her about the PCP but I do remember telling me you go through the 6 months of dieting through the WL center. But, I thought I would at least need a referral from a PCP but when the lady told me at the doctor office I wouldn't need to see a PCP I became really confused. I know all my questions will get answered on the 22nd, I was just seeing if I could get some input before then. Thank you guys for your answers!

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[Jazzzyjay 222]

Don't stress too much. You have plenty of time to get all your ducks in a row.

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[Jazzzyjay 222]

Don't stress too much. You have plenty of time to get all your ducks in a row.

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Sorry I hit the post button before I was done. My experience is that my PCP didn't know a lot of information regarding wls or the requirements involved. She was however happy to help. The bariatric department you are going to be seen at will make sure you get everything done.

I had to do 6 months supervised diets, phyc evaluation, nicotine test, upper GI, lab work. That was for insurance to approve surgery.That was all done early on. My surgery is Jan 17 . Dec 30 I have a informative class I have to attend, more blood work, x ray, ekg, meet with the anaesthesiologist, and a final appointment with my surgeon and her nurse.

I hope that helps kinda put things in perspective for ya???? good luck

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[Jazzzyjay 222]

I had a friend who has Medicaid and did the 6 months of required dieting through the weight loss center. I am going to the same doctor as her, we are in Fayetteville. I haven't asked her yet about the PCP because she just has a baby and I don't want to ask her questions since she's recovering from a C-section and bonding with her new baby. I never thought to ask her about the PCP but I do remember telling me you go through the 6 months of dieting through the WL center. But, I thought I would at least need a referral from a PCP but when the lady told me at the doctor office I wouldn't need to see a PCP I became really confused. I know all my questions will get answered on the 22nd, I was just seeing if I could get some input before then. Thank you guys for your answers!

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Can I ask. What's your BMI? If you have a co morbidity you might need that documentation from your PCP for insurance purposes. I was initially denied because details of my co morbidity was not included in my first request

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[Heagler 18]

It's around 49. Embarrassing to say.

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[Jazzzyjay 222]

Not embarrassing...that's why we are all here...Chin up sweetie. You're on the right track.

The co morbidity thing does not apply to you.

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[mssteal216 45]

Yes that's true with BMI being so high no comorbidity would apply. Mines is in the 50's

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[Edavis1124 3]

Yes that's true with BMI being so high no comorbidity would apply. Mines is in the 50's
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Did you get your surgery? Clevela d clinic does high risk folks. If haven t had it yet.

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[YaYaJae 5]

Heyy, did you have your surgery and how did everything go with Dr. Roller. I am currently in Fayetteville as well.

[Heagler 18]

Yes, I had the surgery. I went to Roller Weight Loss, however Dr. Roller was not my surgeon. Dr. Morout was my surgeon.. He is 1 of the 3 surgeons there. He did a fantastic job. My surgery was June 20, 2016 and so far I have lost 100lbs.