Florida Medicaid Prestige Requirements?

[sparkly0 0]

Hi everyone! I was wondering if anyone had any info on bariatric (VSG) requirements with Prestige Insurance (Florida Medicaid)? I was told by member services that it is covered when medically necessary, but they wouldn’t tell me what the requirements were ie., length of time for supervised diet visits, specific BMI info, nutritional and psychic evaluations. I am scheduled for an informational session in Tampa in a week, but I can’t get any info from my insurance or perspective surgery center and it’s so frustrating. Also if you have any other FL Medicaid insurances and know the surgery requirements for them, pls let me know what they are, bc I’m still within the time frame to switch insurance plans. Any help would be much appreciated. Thanks!

[Asbrin 5]

Hello, I just got off the phone with Florida WellCare and finally got them to confirm what I found with my own research. If you google the HS-006 you can find the WellCare (Staywell) plan booklet that shows the requirements. It’s pretty much the same as other insurances, 35 BMI with a comorbidity or 40 without, medically supervised weight loss program within the last 2 years (doesn’t give timeframe), etc.

[sparkly0 0]

Thanks for the reply. Yes that’s what I’ve found on my own as well, but Prestige doesn’t want to confirm it when I call in, ugh. I’ve also been trying to get an idea of the supervised diet timeframe and they won’t confirm it and I can’t find anything online either. I feel like I’m going nowhere.