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Old 04-24-2011, 08:39 PM   #1 (permalink)
WLS Guru
 
MJ Fan's Avatar
 
Join Date: Apr 2011
Location: Marietta, GA
Posts: 410

Weight Statistics

March 1, 2011
Start Date:
March 24, 2011
Surgery Date:
5' "
Height:
285 lb
Start Weight:
117 lb
Current Weight:
120 lb
Goal Weight:
168 lb
Weight Loss:
-3 lb
Lb Left to Lose:
58.9473684211 %
% Lost:
September 17 - My Birthday
Goal Date:

Body Mass Index
55.6541666667
BMI Start:
22.8475
BMI Current:
23.4333333333
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default What I Had To Due For Medicaid To Approve Me

I had to have my primary care physician give me clearance and I could only get clearance from my pcp if I had a thyroid check that all turned out fine.

I had to do the psychiatrist evaluation everything turned out fine and the cardiologist evaluation which turned out fine. I only had to get the cardiologist evaluation sine I have a heart disease. I also had to see a nutritionist. Only reason I think I did not have to do a sleep study test is I had one done last and I only mild sleep apnea and I did not have to wear a mask at night. It took Medicaid two weeks to approve me. Then I had my surgery scheduled and got a call back saying the surgeon did not take GA Better Health Care which is what Medicaid is through.

My husband called the surgeon's office and said that they should have told us that to begin since on my Medicaid card it says GA Better Health Care. But he was pushy with the surgeon's office. Then a week or two later we got an unexpected call from my surgeon's office saying it is approved. I told my husband to ask is this really for real he asked the insurance person at the surgeon's office and she said it is really for real this time. So I had my surgery March 24 this year. I still don't see why my surgeon didn't take GA Better Health care even though I had Medicaid insurance and he takes Medicaid. My husband and I both think the only reason the surgeon's office worked it out the insurance is because he was very pushy. When we were told the surgeon did not take GA Better Health Care we were both upset not just because I was not getting the surgery but because we spent nearly $1,000 dollars on the evaluations. At least it worked out and I got the gastric bypass surgery.
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Alt Weight Loss Surgery Insurance
Yes, you can often get insurance cover for your Weight Loss Surgery.
Our own Craig "Big-T" Thompson has been there and done that, and he's written an e-book about it.

   
Old 04-24-2011, 08:57 PM   #2 (permalink)
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Join Date: Mar 2007
Location: Floyd County Virginia
Posts: 10,120
Blog Entries: 6

Weight Statistics

September 19th 2007
Start Date:
September 19th 2007and June 18,2012
Surgery Date:
5' 10"
Height:
363 lb
Start Weight:
192 lb
Current Weight:
190 lb
Goal Weight:
171 lb
Weight Loss:
2 lb
Lb Left to Lose:
47.1074380165 %
% Lost:
When I get there again
Goal Date:

Body Mass Index
52.0793877551
BMI Start:
27.546122449
BMI Current:
27.2591836735
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

Honey that 1,000 worth of bills needs to be sent to Medicaid. They should pick that up also. No reason they should not. If they approved you for surgery then that means they approved the surgeon you went to . This is insane you know. Sigh.... when i first started mine I wanted deep in my heart to be a insurance advocate for people.

People think its the Doctors fault for charging so much and its not true. Its the insurance companies. I have dealt with them on a professional level so long I know how that system works. Its not like years ago when we was children. Trust me.
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Old 04-24-2011, 09:20 PM   #3 (permalink)
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Join Date: Oct 2010
Location: S. Jersey
Posts: 3,988
Blog Entries: 4

Weight Statistics

?? Most recently Oct. 2010
Start Date:
January 31 2011
Surgery Date:
5' 9"
Height:
342 lb
Start Weight:
186 lb
Current Weight:
189 lb
Goal Weight:
156 lb
Weight Loss:
-3 lb
Lb Left to Lose:
45.6140350877 %
% Lost:
no pressure... 1 year? 1-2012
Goal Date:

Body Mass Index
50.4990548204
BMI Start:
27.4643982357
BMI Current:
27.9073724008
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

It just goes to show it pays to be persistent. I think we all have to be assertive-not nasty aggressive, but assertive and we need to be sure to follow through on everything.
I kept a notebook. At each appt I wrote the doctor's name and almost everything he/she said. Whenever I spoke to anyone regarding the surgery, I wrote it down, when and who I talked to, and summarized the conversation. It was a help.. you forget things, it is a stressful time, having it in writing helped me.
I think you should put "in" for the $1,000.00 too. All those services were required, they should pay.
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Old 04-24-2011, 09:37 PM   #4 (permalink)
WLS Guru
 
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Join Date: Apr 2011
Location: Marietta, GA
Posts: 410

Weight Statistics

March 1, 2011
Start Date:
March 24, 2011
Surgery Date:
5' "
Height:
285 lb
Start Weight:
117 lb
Current Weight:
120 lb
Goal Weight:
168 lb
Weight Loss:
-3 lb
Lb Left to Lose:
58.9473684211 %
% Lost:
September 17 - My Birthday
Goal Date:

Body Mass Index
55.6541666667
BMI Start:
22.8475
BMI Current:
23.4333333333
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

The reason I had to pay that is the insurance refused to pay for the evaluations. I had my primary doctor send a referral to the nutritionist and it was declined by Medicaid. I just look it at this way $1,000 is not much considering the surgery was around $20,000. My DH called several psychiatrists to see if they accepted Medicaid and none of them did. I only had to pay for 2 out of 4 evaluations.
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Old 04-25-2011, 05:40 AM   #5 (permalink)
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Join Date: Mar 2011
Location: Indiana
Posts: 547
Blog Entries: 23

Weight Statistics

June 6 2011
Surgery Date:
5' 3"
Height:
230 lb
Start Weight:
180 lb
Current Weight:
135 lb
Goal Weight:
50 lb
Weight Loss:
45 lb
Lb Left to Lose:
21.7391304348 %
% Lost:
?
Goal Date:

Body Mass Index
40.7382212144
BMI Start:
31.8820861678
BMI Current:
23.9115646259
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

I am glad everything worked out for you. I worked in the medical field for several years. Part of my job was verifying insurance for patients. Dealing with Indiana Medicaid(which I have now) was frustrating. You could call them 2 separate times and get 2 different answers. Sometimes I had to explain their handbook to them, to prove that they did cover a procedure for a patient!! I have Anthem through medicaid and it is better than before. Momma always said, "what doesn't kill us will make us stronger." LOL, a lil crazier too. Great idea Pretty Woman....I will start doing this asap
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Old 04-25-2011, 07:43 AM   #6 (permalink)
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Join Date: Jul 2009
Location: Long Island, New York
Posts: 328

Weight Statistics

April 6, 2009
Start Date:
October 27, 2009
Surgery Date:
5' 9"
Height:
340 lb
Start Weight:
181 lb
Current Weight:
170 lb
Goal Weight:
159 lb
Weight Loss:
11 lb
Lb Left to Lose:
46.7647058824 %
% Lost:

Body Mass Index
50.2037387104
BMI Start:
26.7261079605
BMI Current:
25.1018693552
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

I'm so glad that you and your DH were persistent and that you were able to have the surgery!! I think it will swerve you well on your WLS journey. Congratulations and continued success.
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54 lbs lost pre-op
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Old 04-25-2011, 11:00 AM   #7 (permalink)
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Join Date: Mar 2011
Location: California
Posts: 317
Blog Entries: 1

Weight Statistics

03/17/2011
Start Date:
03/17/2011
Surgery Date:
5' 2"
Height:
198 lb
Start Weight:
134 lb
Current Weight:
125 lb
Goal Weight:
64 lb
Weight Loss:
9 lb
Lb Left to Lose:
32.3232323232 %
% Lost:
03/17/2012
Goal Date:

Body Mass Index
36.2107180021
BMI Start:
24.5062434964
BMI Current:
22.860301769
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

Good for you!! Congrats Sweety... it does pay to be persistent and Thank you for sharing this story to help others see this as well! I have Blue Cross and they were great!
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Diabetes and Sleep Apnea-GONE!


Don't dig your grave with your own knife and fork.

Bigger snacks mean bigger slacks.

Starting weight DOS: 198 lbs.
1st Goal: 169 *Met 04/20/2011
2nd Goal: 159 *Met 05/21/2011
3rd Goal: 149 *Met 06/17/2011
4th Goal: 139 *Met 07/25/2011
5th Goal: 135 *Met 08/05/2011
Final Goal: 125
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Old 04-26-2011, 09:34 PM   #8 (permalink)
WLS Guru
 
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Join Date: Apr 2011
Location: Marietta, GA
Posts: 410

Weight Statistics

March 1, 2011
Start Date:
March 24, 2011
Surgery Date:
5' "
Height:
285 lb
Start Weight:
117 lb
Current Weight:
120 lb
Goal Weight:
168 lb
Weight Loss:
-3 lb
Lb Left to Lose:
58.9473684211 %
% Lost:
September 17 - My Birthday
Goal Date:

Body Mass Index
55.6541666667
BMI Start:
22.8475
BMI Current:
23.4333333333
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

Quote:
Originally Posted by KatV View Post
I'm so glad that you and your DH were persistent and that you were able to have the surgery!! I think it will swerve you well on your WLS journey. Congratulations and continued success.

Thank you. All though it was my husband who was persistent with the surgeon's office not me. He was really mad at them. I loved it when he said "my wife's insurance card said on the front says GA Better Health Care on it why did no one tell us that Dr. Williams did not accept GA Better Health Care" he was mad too. While we waited to find out if I was approved or not he must of called the surgeon's office over a dozen times. I loved it when my husband said to me they must be so sick of him by now. I found that funny. I couldn't help but laugh when he said that.
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Old 05-21-2012, 02:11 AM   #9 (permalink)
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Join Date: Mar 2011
Location: champaign il.
Posts: 4

Weight Statistics

waiting for surgery date JULY 18, 2012
Surgery Date:
5' 8"
Height:
330 lb
Start Weight:
330 lb
Current Weight:
200 lb
Goal Weight:
130 lb
Lb Left to Lose:

Body Mass Index
50.1708477509
BMI Start:
50.1708477509
BMI Current:
30.4065743945
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default waiting for medicare

I have gone though everything, including what I consider a lot pre op sessions, that took a year. I have seen the Dr, and now we are waiting the approve of medicare. He said it could take up to 2-3 months....
My summer plans are on hold since I don't know when I will have the surgury.. it bothers me. I have a good mind to call the dr office the first week of june, just to say "hi, has is there any good news from medicare?"
I am grateful to now since so much time has time, I have gone over and over, ad nausea about if I really should have the surgery. Now I know for sure.
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Old 05-21-2012, 06:52 AM   #10 (permalink)
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Join Date: Feb 2012
Location: Eastern Shore of Maryland
Posts: 871

Weight Statistics

09/27/11
Start Date:
03/06/12
Surgery Date:
5' 3"
Height:
244 lb
Start Weight:
97 lb
Current Weight:
140 lb
Goal Weight:
147 lb
Weight Loss:
-43 lb
Lb Left to Lose:
60.2459016393 %
% Lost:
03/06/13
Goal Date:

Body Mass Index
43.2179390275
BMI Start:
17.1809019904
BMI Current:
24.7971781305
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

MJ Fan I had mine done through Maryland Medicaid sponsored through Johns Hopkins Priority Partners. In another thread I had listed down the expenses they medicaid paid and what I paid.

I know where Vickie is coming from but since the medicaid system is run through FEDERAL funds the regulations are the same in every state. Each state may have something set up in addition to what the federal regulations are but they have to follow federal first. They will not pay for evals. The only way around that is if you went to that Dr. for a previous issue already referred by your PCP. Like if you had the heart condition you ALREADY see that particular cardiologist for on a regular (I think it has to be at least every 90 days) basis. And they will not pay the program fee that most places have or the psych eval usually. That is the same for regular insurances too, some things they pay for, some they don't If I remember right, my out of pocket was around $1700 so far.

What I needed:
I was in the first 5 people at my center with medical assistance to be accepted there so I was a bit of a guinea pig.
-history of documented previous weight loss efforts. Like I had to even provide the contract and/or the receipts from the Jenny Craig program from 2 years ago type stuff
-weight loss effort with my pcp and pcp referral
-bmi over 35 or 25-30 with co-morbidness (I had co's and that is what approved me though my bmi was lower)
-6 months of food journals reviewed by wls surgeon seen at LEAST once per month. They will deny you if you are a day short or missing even one day of food journal (edited to add) if I missed even one appointment in the month and didn't make it up within the same month I would have to start the whole six months over again
-psych evaluation and follow ups
-attend 6 month nutrition counseling and wls counseling
-show ability to handle financially and emotionally life after surgery
-sign contract about not drinking alcohol for at least a year after surgery
-sign contract for exercise

Between medical assistance and my own personal wls Dr.'s opinion about why people relapse and fail a couple years out they put these rules into place so people can have long term success.
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