Medicare/Medicaid requirements

[Rina5191 6]

Hi, I'm at the very beginning stages of the WLS process. Can anyone tell me exactly what the requirements are for Medicare/Medicaid approval? I would like to know about how long it takes for them to approve the surgery. Thank you for any help offered.

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[Olypie 41]

I have Illinois Medicaid and had to do a 6 month doctor supervised weight loss program. Basically showing I was trying to lose weight.

Also had to have more than 100 pounds to lose and at least two comorbidities.

After the 6 months I had to have a psych consult, labs, meet with nutritionist, an ekg and upper GI.

After all that was finished, about 9 months it took about a month to get approval and a date set.

Hope that helps. I'm sure some of what I had to do was from my surgeon rather than Medicaid so it might be a bit different for you. Good luck on your journey!

[maccc74 24]

I too have Medicaid. It took me a little over a year from when I started with calling to make my first appointment to surgery date.

I had to do 6 months of nutritionist and psychology. I had to have a ekg, edg, sleep study, and about 16 vials of blood taken. You have to see the medical doctor and she has to approve you for surgery and the surgeon.
The place I went was Loyola and they make sure that they have everything they need before they submit to Medicaid. They very rarely have any denials. I did call and check on my test when I had them done to make sure they had received them and some of them did take awhile to be in putted in my chart. I leave out of town so I had majority of my test in my town and then the faxed the results.

Good luck!!!


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[TeePalmer 0]

Which IL Plan do you guys have? I have Illinicare and I was told they do not cover weight loss surgery.