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.